Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year survival rate of approximately 10% ¹. Unfortunately, surgical resection is indicated in < 20% of patients ². Many of these patients have distant metastases, which decreases the median overall survival time to < 1 year, and most die within 2 years ³. PDAC most frequently metastasizes to the liver (76%), followed by the lungs (19.9%). The brain (0.6%) is extremely rare site of metastasis⁴. However, in a few cases, long-term survival has been achieved via multidisciplinary treatment including chemotherapy, radiotherapy, and local excision, even after distant metastasis, such as lung and brain metastases, was observed ^5,6. Herein, we report the case of a patient with PDAC who achieved long-term survival after pylorus-preserving pancreaticoduodenectomy (PpPD) despite metachronous lung and brain metastases.