Surgical case reports · 2026
Exceptional Long-Term Survival after Resection of Metachronous Liver and Lung Metastases Following Surgery for Pancreatic Cancer: A Case Report.
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Miwa Takumi, Takahashi Makoto, Hayashi Tatsuya, Shikura Shogo, Sato Hayato, Tsuji Taiki, Ichinose Akinori, Higashihara Taku, Sakaibori Yuko, Kikkawa Takuma, Inoue Dai, Ishii Hideaki, Araki Junko, Kai Tomonori, Okada Haruka, Morita Yasuhiro
Аннотация
INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, especially in patients with distant metastases. However, recent advances in multidisciplinary treatment strategies, including surgical resection, have led to successful outcomes even in patients with metastatic PDAC. Nevertheless, few cases have been reported with 2 or more resections of metachronous distant metastases. Herein, we report a case of PDAC in which a metachronous hepatic metastasis was successfully resected following prolonged chemotherapy after curative pancreatectomy and in which a metachronous pulmonary metastasis was subsequently resected following additional chemotherapy.
CASE PRESENTATION: A 69-year-old man was diagnosed with PDAC and received neoadjuvant chemotherapy in October 2019. In March 2020, a subtotal stomach-preserving pancreaticoduodenectomy was performed. The patient received 1 year of adjuvant chemotherapy following surgery. In September 2021, 18 months after surgery, CT showed a 10-mm nodule in segment (S) 6 of the liver, which was diagnosed as a hepatic recurrence of PDAC. After 19 months of chemotherapy, the metastatic liver lesion remained solitary and showed no change in size, suggesting that the tumor was well-controlled. In June 2023, a partial hepatectomy of S6 was performed. Chemotherapy with S-1 was continued after hepatic resection; however, a metastatic pulmonary lesion in the right lower lobe was identified on CT 15 months after the liver surgery. Right lower lobe partial resection was performed using video-assisted thoracoscopic surgery in January 2025. The patient remains alive and recurrence-free 1 year after the last surgery, 6 years and 1 month after the initial surgery, and 6 years and 6 months after the start of treatment.
CONCLUSIONS: This report describes a case of long-term survival achieved with a multidisciplinary approach, including 2 surgical resections, for recurrent disease following a diagnosis of PDAC.
CASE PRESENTATION: A 69-year-old man was diagnosed with PDAC and received neoadjuvant chemotherapy in October 2019. In March 2020, a subtotal stomach-preserving pancreaticoduodenectomy was performed. The patient received 1 year of adjuvant chemotherapy following surgery. In September 2021, 18 months after surgery, CT showed a 10-mm nodule in segment (S) 6 of the liver, which was diagnosed as a hepatic recurrence of PDAC. After 19 months of chemotherapy, the metastatic liver lesion remained solitary and showed no change in size, suggesting that the tumor was well-controlled. In June 2023, a partial hepatectomy of S6 was performed. Chemotherapy with S-1 was continued after hepatic resection; however, a metastatic pulmonary lesion in the right lower lobe was identified on CT 15 months after the liver surgery. Right lower lobe partial resection was performed using video-assisted thoracoscopic surgery in January 2025. The patient remains alive and recurrence-free 1 year after the last surgery, 6 years and 1 month after the initial surgery, and 6 years and 6 months after the start of treatment.
CONCLUSIONS: This report describes a case of long-term survival achieved with a multidisciplinary approach, including 2 surgical resections, for recurrent disease following a diagnosis of PDAC.