Preoperative Chemotherapy plus Immune Checkpoint Inhibitors as Conversion Therapy in Pancreatic Cancer Patients with Initially Unresectable Liver-limited Metastases: A Case Report

Pancreatic cancer (PC) is a lethal tumor, and overall survival (OS) is poor, especially for patients with liver metastases. Herein, we report a 55-year-old female who presented with right upper quadrant pain. Computed tomography (CT) of the upper abdomen revealed a large space-occupying lesion (5.5×5.2 cm) in the pancreatic neck with multiple liver metastases. After biopsy confirmation, the patient underwent conversion therapy consisting of doublet chemotherapy (gemcitabine 1,000 mg/m2 and nab-paclitaxel 125 mg/m2) and toripalimab (a novel PD-1 inhibitor, 240 mg). After six and a half cycles, radical pancreaticoduodenectomy combined with resection of liver metastases and portal vein replacement were performed successfully. The patient died from hemorrhage of the pancreaticojejunostomy anastomotic stoma four months after surgery. No recurrence or metastases were detected by CT until the patient died. This is the first study to report the results of conversion surgery in patients with metastatic PC limited to the liver after preoperative chemotherapy plus a PD-1 inhibitor. Stage IV PC should not be considered a general contraindication for surgical resection in well-selected patients. A multicenter randomized controlled study should be performed to investigate the efficacy and safety of this controversial treatment strategy.