An 8-Year Survivor after Three-Time Hepatectomies for Metachronous Pancreatic Adenocarcinoma Liver Metastases - Case Report

Sep 30, 2026

Surgical management of recurrent pancreatic ductal adenocarcinoma (PDAC) after initial resection remains difficult, particularly when metachronous liver metastases are involved and operative indications are limited. A 60-year-old woman developed metachronous hepatic lesions after distal pancreatectomy, received sequential chemotherapy with gemcitabine plus nab-paclitaxel, and underwent three hepatectomies combined with radiofrequency ablation across different liver segments. Multidisciplinary therapy enabled survival beyond eight years with no evidence of disease.

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SURGICAL CASE REPORTS Surg Case Rep 2026; 12: 25-0242 Case Report An 8-Year Survivor after Three-Time Hepatectomies for Metachronous Pancreatic Adenocarcinoma Liver Metastases Toshiro Masuda,1,2 Hirohisa Okabe,1 Takeshi Morinaga,1 Naoki Umezaki,1 Hidetoshi Nitta,1 Masahiko Hirota,1 Ryoichi Kurano,3 Toru Beppu,2 and Hiroki Sugita1 ABSTRACT INTRODUCTION: Recurrence of pancreatic ductal adenocarcinoma (PDAC) after primary resection remains a challenging condition, and operative indications for metachronous liver metastases are limited. CASE PRESENTATION: A 60-year-old woman with no elevation of carcinoembryonic antigen, carbohydrate antigen 19-9, and Duke pancreatic monoclonal antigen type 2 underwent a distal pancreatectomy for PDAC. Two years and 4 months after the primary surgery, metachronous liver metastases in liver segments 4 and 5 were diagnosed. After receiving 8 courses of bi-weekly gemcitabine plus nab-paclitaxel, a partial liver resection of segment 5 with radiofrequency ablation (RFA) of segment 4 was performed. A laparoscopic partial liver resection of segment 8 was performed for another liver metastasis 5 years and 2 months after the primary resection. An open partial liver resection of segment 8 was performed for the liver recurrence adjacent to the previous resection area 7 years and 2 months after the initial pancreatectomy. More than 8 years have passed since the initial pancreatic surgery, and she is currently alive without disease. CONCLUSION: Multidisciplinary treatment, including chemotherapy, resection, and RFA, may increase survival time in selected PDAC patients. KEYWORDS: pancreatic ductal adenocarcinoma, liver metastasis, liver resection Abbreviations CA19-9 carbohydrate antigen 19-9 CEA carcinoembryonic antigen DUPAN-2 Duke pancreatic monoclonal antigen type 2 1Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Kumamoto, Japan 2Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, Japan 3Department of Pathology, Kumamoto Regional Medical Center, Kumamoto, Kumamoto, Japan Corresponding author: Toshiro Masuda. Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Yamaga, Kumamoto 860-0593, Japan [E-mail: masuda1046@yahoo.co.jp](E-mail: masuda1046@yahoo.co.jp) Received: July 23, 2025; Accepted: December 7, 2025 DOI: 10.70352/scrj.cr.25-0242 Supplementary materials are available online. PDAC pancreatic ductal adenocarcinoma RFA radiofrequency ablation INTRODUCTION Recurrence of pancreatic ductal adenocarcinoma (PDAC) after primary resection remains a challenging condition, and chemotherapy is mostly considered to be the first choice for treatment. 1–3) Patients with isolated metachronous lung oligometastases are reportedly good candidates for surgical resection.4–6) However, the operative indication for metachronous liver metastases is limited.2,7) According to a review article on surgically treated PDAC patients with metachronous liver metastases, the median interval from pancreas surgery to hepatectomy, overall survival after hepatectomy, and overall survival after initial pancreatectomy were 7.6 to 18.4, 11.4 to 31.0, and 24.5 to 40 months, respectively.8) © 2026 The Author(s) . Published by Japan Surgical Society This article is licensed under a Creative Commons Attribution 4.0 International License. Masuda T. et al. 0 1 2 3 4 5 6 7 8 (years) 4 years CEA (ng/mL) 10 1 year and 2 years 2 months Fig. 1 Clinical treatment course and the changes of tumor markers of the current patient. CA19-9, carbohydrate antigen 19-9; CEA, carcinoembryonic antigen 19-9; GEM, gemcitabine; nabPTX, nab-paclitaxel; RFA, radiofrequency ablation -2015 -2015 -2015 -2016 -2016 -2016 -2016 -2016 -2016 -2017 -2017 -2017 -2017 -2017 -2017 -2018 -2018 -2018 -2018 -2018 -2018 -2019 -2019 -2019 -2019 -2019 -2019 -2020 -2020 -2020 -2020 -2020 -2020 -2021 -2021 -2021 -2021 -2021 -2021 -2022 -2022 -2022 -2022 -2022 -2022 -2023 -

FAQs

Why are operative indications for metachronous liver metastases in PDAC limited?

Recurrence of PDAC after primary resection is challenging, and the document notes that operative indications for metachronous liver metastases are limited.

What treatments were used for the patient’s liver metastases?

After chemotherapy with gemcitabine plus nab-paclitaxel, the patient underwent partial liver resections and radiofrequency ablation (RFA) across liver segments for separate metastatic episodes.

How long did the patient survive after the initial pancreatic surgery?

More than eight years have passed since the initial pancreatectomy, and she is currently alive without disease.

Sep 30, 2026

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