Background <p>Pancreatic carcinoma is a highly malignant tumor, and it is aggressive even in its early stage. It has a very poor prognosis and responds poorly to systemic therapy. It is common for resected patients to undergo postoperative adjuvant chemotherapy. However, survival remains low, with an average 5-year survival of 10–25% and median survival between 10 and 20&#xa0;months.</p> Case presentation <p>A 50-year-old Malaysian Chinese gentleman with no past medical history was diagnosed with stage IIb pancreatic cancer. A computed tomography scan of the abdomen showed a tumor at the uncinate lobe of the pancreatic head. He underwent a Whipple pancreaticoduodenectomy followed by postoperative chemotherapy with gemcitabine combined with 5-fluorouracil for 6&#xa0;months. However, a rising carbohydrate antigen 19-9 level and a positron emission tomography–computed tomography scan showing a ¹⁸F-fluorodeoxyglucose avid focus above the resected pancreas led to a repeat laparotomy 10 months after the first surgery. Even though an omental tissue biopsy at the area of the hepatic flexure was normal, the CA19-9 level continued to increase, indicating tumor recurrence. Subsequently, the patient was treated with 25 fractions of radiotherapy to the peripancreatic lymph nodes followed by tegafur–gimeracil–oteracil potassium maintenance. He went on to achieve a progression-free survival of more than 5 years with good tolerability and no adverse drug induced reaction. More than 9&#xa0;years into treatment, he continues to enjoy good health and quality of life and is tolerating the treatment well.</p> Conclusion <p>This case shows an exceptional long-term survival of a patient with pancreatic cancer with early recurrence after adjuvant chemotherapy treated with maintenance tegafur–gimeracil–oteracil potassium.</p>