Pancreatic cancer is a highly malignant tumor of the digestive system, with insidious onset and basically no symptoms in the early stage. Even if surgery is performed, the recurrence and metastasis rates are extremely high after surgery, and it is considered as the “king of cancer”. Advanced pancreatic cancer is very prone to liver metastasis. The liver is the most important organ for nutrient metabolism, and the blood flow is up to 1/4 of the blood expelled from the heart; the liver is supplied with abundant blood mainly through two systems: the hepatic artery and the portal vein. Of these, 25% comes from the hepatic artery and 75% from the portal vein. When pancreatic cancer occurs, due to the abundant blood flow in the liver, it becomes the first destination for cancer cells to “drift” with the blood. Therefore, it is very common for pancreatic cancer to develop liver metastasis in clinical practice. How to treat liver metastasis in advanced pancreatic cancer? First, we need to determine whether the patient has obstructive jaundice. When pancreatic cancer metastasizes to the liver, most patients will have jaundice, which is manifested as itchy skin, strong tea-colored urine, and feces turning into clay color. Jaundice in pancreatic cancer patients is mostly caused by the compression of the common bile duct by the tumor located in the head of the pancreas, and in some patients due to the metastasis of pancreatic body tail cancer to the intrahepatic or hepatic/general bile duct lymph nodes. In general, obstructive jaundice in pancreatic head cancer appears earlier in the course of the disease. In case of pancreatic body and tail cancer, most of them do not have jaundice symptoms. The larger the size of the pancreatic cancer tumor, the more severe the jaundice obstructive will be. If pancreatic cancer combined with obstructive jaundice is found, firstly, bile duct puncture and drainage surgery (PTCD procedure) or endoscopic biliary stenting (ERCP procedure) for bile drainage is needed to restore normal liver function before further anti-tumor treatment. Secondly, we need to obtain pathological diagnosis before pancreatic cancer treatment After liver metastasis of pancreatic cancer, most patients lose the chance of surgical resection. In order to carry out subsequent anti-tumor treatment, we need to perform percutaneous puncture under imaging guidance or ultrasound endoscopic guidance of pancreatic tumor, and we can also perform pathological puncture biopsy for liver metastasis, because histopathological diagnosis is the gold standard to confirm the diagnosis of pancreatic cancer, and it is also the most important basis to guide the subsequent Histopathological diagnosis is the gold standard for pancreatic cancer diagnosis and the most important basis to guide the subsequent treatment. The pathological diagnosis can not only clarify the histological type of pancreatic cancer and the degree of tumor differentiation, but also perform genetic tests such as KRAS, NRAS, BRAF, BRACA1/2, dMMR, MSI, TMB, NTRK, HER-2, etc., to guide the subsequent targeted or immunotherapy. After the pathological diagnosis is obtained, the decision of subsequent treatment needs to be based on the patient’s fitness score. For patients in good physical status, systemic chemotherapy is the preferred treatment option. First-line chemotherapy regimens include gemcitabine combined with albumin paclitaxel (AG regimen), oxaliplatin, irinotecan combined with fluorouracil (FOLFORINOX regimen) treatment. For patients with poor physical status, gemcitabine or tegeo monotherapy is recommended, or best supportive care and participation in clinical studies. Patients with liver metastases from pancreatic cancer require a combination of systemic chemotherapy treatment and local treatment Pancreatic cancer is a tumor that is insensitive to both radiotherapy and chemotherapy, and requires a combination of systemic and local treatment to achieve a better treatment outcome. For the treatment of patients with liver metastases from pancreatic cancer, if the metastases are oligometastases (single metastases) or the number of metastases does not exceed 3 and the location of the lesions is relatively limited, local surgery can be considered for resection and adjuvant chemotherapy after surgery. If the patient cannot tolerate surgery, microwave or radiofrequency ablation can also be used to destroy the metastases through minimally invasive methods. For patients with a large number of metastases, liver intervention can be used, including traditional iodine oil intervention, new drug-laden microsphere intervention or hepatic artery infusion chemotherapy to improve the efficacy of treatment by increasing the local drug concentration in liver metastases. There is good news about the targeted therapy for pancreatic cancer. Since the 21st century, the overall treatment of advanced solid tumors has changed from the era of radiotherapy to the era of targeted immunotherapy. As the “king of cancer”, pancreatic cancer is far behind other solid tumors in the exploration of targeted and immunotherapy efficacy. For a highly malignant cancer like pancreatic cancer, after the failure of first-line chemotherapy, the number of patients who can receive second-line chemotherapy is significantly reduced due to their physical condition and disease progression, and targeted or immunotherapy drugs with fewer side effects are of great significance for patients with advanced pancreatic cancer. However, for a long time, several new drug clinical studies have shown that no single targeted drug monotherapy has significant efficacy in advanced pancreatic cancer. In 2019, pancreatic cancer is finally receiving the first molecular biomarker-guided targeted drug, olaparib. In the POLO clinical study exploring the efficacy of targeted therapy for advanced pancreatic cancer, Olaparib as maintenance therapy after first-line platinum-based chemotherapy (PBC) in patients with germline BRCA-mutated metastatic pancreatic cancer nearly doubled median tumor progression-free survival in patients with advanced pancreatic cancer (Olaparib 7.4 months vs. placebo 3.8 months) and reduced the risk of tumor progression by 47% In 2020, the new NCCN guidelines recommend maintenance therapy with olaparib after first-line platinum-containing chemotherapy for patients carrying a BRCA germline mutation. In terms of immunotherapy, pancreatic cancer has been considered a “cold tumor” in immunotherapy, mainly because of the low immunogenicity of pancreatic cancer cells, the lack of effector lymphocytes in the tumor tissue, and the large infiltration of immunosuppressive cells. Therefore, immunotherapy alone cannot improve the prognosis of pancreatic cancer patients. However, patients can be genetically and molecularly typed by genetic testing to precisely identify the population that will benefit from immunotherapy. If genetic testing suggests high expression of MSI-H or PD-L1, TMB, patients can use PD-1 combined with chemotherapy or targeted therapy to improve tumor control rate. With the continuous development of new drugs and clinical trials (gemcitabine combined with tumor vaccine, TNF-α and dendritic cell vaccine, PD-1 antibody combined with CTLA-4 antibody), it is believed that immunotherapy will eventually be more and more widely used in pancreatic cancer, ushering in a spring of “blossoming”. Combination of Chinese and Western medicine for comprehensive treatment Late stage pancreatic cancer is the most difficult to treat among solid tumors of the digestive system. In addition to Western medicine, Chinese herbal medicine can be used throughout the whole treatment process of pancreatic cancer, which is one of the comprehensive treatment methods for pancreatic cancer. Compared with western medicine, TCM helps to enhance the immunity of the body, and the combination with chemotherapy and radiotherapy can improve the synergistic anti-cancer ability, reduce the toxicity of radiotherapy, improve the clinical symptoms of advanced pancreatic cancer patients, improve the quality of life of patients, and potentially prolong the survival. For example, a recent phase II clinical study conducted in the United States showed that Conrad combined with gemcitabine significantly prolonged progression-free survival and overall survival of pancreatic cancer patients compared to gemcitabine alone (Class IIB evidence). However, overall, the evidence-based medical evidence for the treatment of pancreatic cancer with Chinese medicine is insufficient and lacks high-level evidence to support it. Further clinical observations and studies are needed to provide an objective basis for the standardized treatment of pancreatic cancer with Chinese medicine.