Treatment strategies for pancreatic cancer after liver metastasis Pancreatic cancer is one of the peri-pot belly cancers. There are four sources of peri-potbelly cancer, pancreatic head origin, lower bile duct origin, jugular abdominal origin and duodenal origin. Why is it collectively called peri-pot belly cancer? Because this is the site where the pancreas, bile duct and duodenum intersect, and it is more difficult to determine the exact tissue structure of origin of tumors in this area before surgery. However, the malignancy of tumors of different origins is inconsistent. Among them, the pancreatic origin is the least effective. The treatment of liver metastases from this site of cancer is still widely debated and has conflicting results. Traditionally, it is believed that liver metastasis from this site is already very advanced and has no value for surgery, and surgical treatment cannot improve survival; such patients are mostly treated with chemotherapy or herbal medicine, and very and some cases in China choose surgery. In Europe and the United States, due to the influence of good surgical results of liver metastases from colorectal cancer, some scholars have tried surgical treatment for cases of peri-pot belly cancer with liver metastases, including pancreatic cancer, and then the results achieved are not consistent. There are equally simultaneous and heterochronic liver metastases from peri-pot belly cancer. By concurrent metastasis: it means that the liver metastases found at the time of initial diagnosis of the primary cancer or surgical exploration are called concurrent metastatic cancer. The diagnosis of concurrent metastatic cancer is affected by various factors, such as the doctor’s treatment technique, the early and late stage of the disease, the auxiliary diagnosis technique, the selection of surgical pointers, and the surgical exploration technique, and the literature reports that the incidence is 10-25%. Heterochronous metastases: Liver metastases found within a period of time after resection of primary malignant tumors outside the liver. In 40 appropriate cases of pancreaticoduodenectomy plus hepatectomy including simultaneous hepatectomy (27/40) and hepatectomy with heterochronous metastases (13/40), the mortality rate after surgery was 5% and the incidence of major complications was 30%. The overall median postoperative tumor-free survival was 10 months, the median survival was 17 months, and the 1- and 3-year survival rates were 55% and 18%. The median survival was 16 months for simultaneous hepatectomy and 19 months for heterochronic hepatectomy. Postoperatively, 22/40 cases recurred, and the 1- and 3-year survival rates were 28% and 12%. In contrast, the median survival in cases without surgery was 7 months, and the 1- and 3-year survival rates were 18% and 2%. Among the recurrent cases after surgery, 14 cases were intrahepatic only, 3 cases were extrahepatic only, and 5 cases were intrahepatic and extrahepatic. 2 of the 19 cases of intrahepatic recurrence were surgically resected and 2 were treated with radiofrequency, and the median survival was 30 months, while the median survival was only 7 months in cases without treatment. Among them, cancers of pancreatic and biliary tract origin were poorly treated, while cancers of intestinal origin: duodenal and pot-belly origin were better treated. The authors suggested that for peri-pot belly cancer with combined liver metastases, if the primary site is of biliopancreatic origin, surgical treatment is not recommended, while for cancer of intestinal origin, aggressive treatment is recommended. It has also been reported that 5-year survival could reach 27% after isochronous hepatectomy in 84 cases of pancreaticobiliary origin cancer, while another scholar reported that the median survival was only 5.6 months in 22 cases with simultaneous pancreaticoduodenectomy plus hepatectomy, and the 1-year and 3-year survival rates were 13.3% and 6.7%. It seems that the results of hepatectomy with heterochronic resection are better than the cases with simultaneous resection. In summary of the latter, I personally believe that surgical resection can also be considered for isolated postoperative liver metastases from pancreatic cancer and peri-potbelly cancer in the absence of extrahepatic metastases.