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Molecular and Clinical Oncology
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Case Report Open Access

Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report

  • Authors:
    • Taiki Tsuji
    • Makoto Takahashi
    • Kaoruko Funakoshi
    • Taku Higashihara
    • Tatsuya Hayashi
    • Haruka Okada
    • Junko Araki
    • Natsuki Miura
    • Yasuhiro Morita
  • View Affiliations / Copyright

    Affiliations: Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo 183‑8524, Japan, Department of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo 183‑8524, Japan, Department of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo 183‑8524, Japan, Department of Gastroenterology, Tokyo Metropolitan Tama Medical Center, Tokyo 183‑8524, Japan
    Copyright: © Tsuji et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 110
    |
    Published online on: October 13, 2025
       https://doi.org/10.3892/mco.2025.2905
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Abstract

The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) with liver metastasis is poor; therefore, chemotherapy is often selected instead of surgical intervention. However, there are some reports of cases becoming resectable after multidisciplinary treatment. On the other hand, there have been a few cases of long‑term survival in which liver metastases were resected first, followed by prolonged chemotherapy and subsequent resection of the primary tumor. The present study describes the case of a patient with PDAC in which a liver metastasis was resected first, followed by chemotherapy and subsequent resection of the primary tumor, resulting in long‑term survival. Briefly, a 72‑year‑old man diagnosed with resectable PDAC was scheduled to undergo subtotal stomach‑preserving pancreaticoduodenectomy after neoadjuvant chemotherapy. Intraoperatively, a liver metastasis was detected, and partial hepatectomy was performed. The patient received 13 cycles of modified 5‑fluorouracil, leucovorin, irinotecan and oxaliplatin. A subtotal stomach‑preserving pancreaticoduodenectomy was then performed when no new lesions were observed. The patient received S‑1 as adjuvant chemotherapy for 1 year postoperatively. Currently, 5 years after diagnosis, and 4 years and 3 months after the last surgery, the patient has experienced no recurrence. In conclusion, even if curative surgery is not possible because of a liver metastasis at the time of the initial operation, some patients may achieve long‑term survival through resection, and preoperative and postoperative chemotherapy.
View Figures

Figure 1

Image findings of contrast-enhanced
dynamic-computed tomography before neoadjuvant chemotherapy. Image
shows a hypovascular tumor of the pancreatic head (yellow
arrow).

Figure 2

Hematoxylin and eosin staining of the
endoscopic ultrasound-fine-needle aspiration specimen revealed
focal nuclear enlargement and disorganized nuclear arrangement;
however, atypical cells were scarce, and a definitive diagnosis of
adenocarcinoma could not be established.

Figure 3

Intraoperative finding. A 1.5-cm
nodule on the surface of liver segment 3 (S3) (yellow arrow).

Figure 4

Image findings of the
contrast-enhanced dynamic-computed tomography performed after NAC.
Image shows an 8-mm ring-enhanced nodule in liver segment S3
(yellow arrow).

Figure 5

(A) H&E staining of the pancreatic
specimens. Atypical cells with enlarged, round nuclei and strong
staining proliferated invasively while forming large, irregularly
shaped glandular ducts. Immunohistochemical staining of the
pancreatic specimens; (B) CK7 and (C) CK20 were positive. (D)
H&E staining of the hepatic specimen. It shows an appearance
similar to that of the pancreatic specimen. Immunohistochemical
staining of the hepatic specimens; (E) CK7 and (F) CK20 were
positive. Scale bar, 200 µm. H&E, hematoxylin and eosin.

Figure 6

(A) In pancreatic specimens,
immunohistochemical staining for α-SMA revealed diffuse staining of
the stroma surrounding the carcinoma, but no areas showed
particularly strong positivity. (B) Immunohistochemical staining of
the pancreatic specimens. CD10 was negative in the stromal cells.
α-SMA, α-smooth muscle actin. Scale bar, 500 µm.

Figure 7

Clinical course of this patient.
Throughout the course, the tumor markers consistently remained
within the normal range. GS, combination therapy of gemcitabine and
S-1; mFOLFIRINOX, modified 5-fluorouracil, leucovorin, irinotecan,
and oxaliplatin; CA19-9, carbohydrate antigen 19-9; CEA,
carcinoembryonic antigen.
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Copy and paste a formatted citation
Spandidos Publications style
Tsuji T, Takahashi M, Funakoshi K, Higashihara T, Hayashi T, Okada H, Araki J, Miura N and Morita Y: Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report. Mol Clin Oncol 23: 110, 2025.
APA
Tsuji, T., Takahashi, M., Funakoshi, K., Higashihara, T., Hayashi, T., Okada, H. ... Morita, Y. (2025). Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report. Molecular and Clinical Oncology, 23, 110. https://doi.org/10.3892/mco.2025.2905
MLA
Tsuji, T., Takahashi, M., Funakoshi, K., Higashihara, T., Hayashi, T., Okada, H., Araki, J., Miura, N., Morita, Y."Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report". Molecular and Clinical Oncology 23.6 (2025): 110.
Chicago
Tsuji, T., Takahashi, M., Funakoshi, K., Higashihara, T., Hayashi, T., Okada, H., Araki, J., Miura, N., Morita, Y."Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report". Molecular and Clinical Oncology 23, no. 6 (2025): 110. https://doi.org/10.3892/mco.2025.2905
Copy and paste a formatted citation
x
Spandidos Publications style
Tsuji T, Takahashi M, Funakoshi K, Higashihara T, Hayashi T, Okada H, Araki J, Miura N and Morita Y: Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report. Mol Clin Oncol 23: 110, 2025.
APA
Tsuji, T., Takahashi, M., Funakoshi, K., Higashihara, T., Hayashi, T., Okada, H. ... Morita, Y. (2025). Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report. Molecular and Clinical Oncology, 23, 110. https://doi.org/10.3892/mco.2025.2905
MLA
Tsuji, T., Takahashi, M., Funakoshi, K., Higashihara, T., Hayashi, T., Okada, H., Araki, J., Miura, N., Morita, Y."Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report". Molecular and Clinical Oncology 23.6 (2025): 110.
Chicago
Tsuji, T., Takahashi, M., Funakoshi, K., Higashihara, T., Hayashi, T., Okada, H., Araki, J., Miura, N., Morita, Y."Liver metastasis surgery followed by radical treatment for pancreatic ductal adenocarcinoma: A case report". Molecular and Clinical Oncology 23, no. 6 (2025): 110. https://doi.org/10.3892/mco.2025.2905
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