Case Report: Late repeat pancreatic irreversible electroporation in the long-term multidisciplinary management of unresectable pancreatic ductal adenocarcinoma.

Unresectable locally advanced pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, particularly after distant metastasis. Irreversible electroporation (IRE) is a nonthermal ablative technique used for pancreatic tumors adjacent to major vessels, but evidence on late repeat pancreatic IRE remains limited. We report a 62-year-old man who presented with obstructive jaundice. Multidisciplinary evaluation classified the tumor as unresectable locally advanced PDAC involving the superior mesenteric vein-portal vein confluence. In January 2021, he underwent pancreatic IRE with biliary bypass, followed by sequential systemic therapy. Liver metastases developed approximately 10 months later and were treated locally, after which he continued multimodal therapy. In April 2025, gastroscopy revealed deformity and luminal narrowing of the duodenal bulb, accompanied by gastric retention, for which laparoscopic gastrojejunostomy was performed. In late 2025, a marked rise in carbohydrate antigen 19-9 (CA19-9) and tumor progression prompted multidisciplinary reassessment. Nearly 5 years after the initial procedure, he underwent repeat pancreatic IRE combined with radiofrequency ablation of a hepatic metastasis. During subsequent multimodal management, CA19-9 decreased from 12,280.0 to 291.4 U/mL. As of March 2026, he remained alive with disease, with an overall survival exceeding 62 months. This case demonstrates the technical feasibility of repeat pancreatic IRE after a prolonged interval and supports its potential role as an individualized local treatment within long-term multidisciplinary management.