A 45-year-old man with unresectable locally advanced pancreas
head cancer with multiple synchronous liver
metastases was treated with
gemcitabine plus
nab-paclitaxel therapy as a first-line
chemotherapy. During 24 months of 30 courses of this
therapy, the primary lesion remained stable and liver
metastases were completely disappeared on CT. Three months later, however, solitary relapse of liver
metastasis occurred in segment 2. Therefore, we changed the
chemotherapy regimen to the second-line treatment,
FOLFIRINOX. After 3 courses of
FOLFIRINOX, the primary lesion was kept well-controlled, but the solitary metastatic liver lesion was enlarged. An interdisciplinary team suggested surgical resection of the liver
metastasis to control disease progress. We performed laparoscopic lateral
segmentectomy of the liver. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. The patient underwent another round of
gemcitabine therapy owing to the good response of the primary pancreatic lesion to this drug. Three years after starting the first-line
chemotherapy, the patient is still alive with well-controlled PDAC without distant
metastasis. Surgical intervention for liver
metastases may be a promising treatment option when unresectable primary PDAC is well controlled by
chemotherapy.