1. IntroductionPancreatic 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.