Background : Pancreatic cancer is a significant public health problem in Korea, with an increasing incidence rate in recent years. The prognosis of pancreatic cancer in Korea is poor, with a 5-year survival rate of only 9.5%. The prognosis of pancreatic cancer at stage 4 is especially poorer, with a median survival period of 3 to 6 months.

Methods : Our patient was first diagnosed with pancreatic cancer in August 2019. In the initial CT scan, the cancer had already invaded not only the head of the pancreas, but also the superior mesenteric vein (SMV), splenic vein (SV), and main portal vein (PV). In addition, seeding metastasis was strongly suspected, excluding surgery as a treatment option.

Results : The medical staff performed about 20 cycles of Gemcitabine/Nab-paclitaxel combination as palliative chemotherapy according to Korean Pancreatic Cancer treatment recommendations. After subsequent palliative chemotherapy, CA19-9 level immediately decreased and was stable until interruptions of chemotherapy resulted in some fluctuations. The patient refused further chemotherapy after the 20th cycle was completed in November 2021. Aside from cancer, the patient was diagnosed with chronic cholangitis with CBD stones, liver abscess and acute enterocolitis. The patient was admitted for the final time in June 2022 due to abdominal pain due to acute gastroenteritis. With deteriorating condition, the patient requested transfer to local hospital for hospice and expired shortly after, some 34 months after the initial diagnosis.

Conclusions : The patient’s initial sensitivity and lack of resistance to chemotherapy, good nutrition and physical health seem to be main contributors to the patient’s exceptional survival time.