Resection of the primary tumor with or without liver resection reduces the risk of death in patients with liver metastatic gastroenteropancreatic neuroendocrine tumors: a systematic review and meta-analysis

Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) patients frequently present with liver metastases (LM) at diagnosis. The benefit of primary tumor resection (PTR) in this context remains controversial. This meta-analysis aimed to quantify the effect of PTR on survival in GEP-NETs patients with LM. Methods: We performed a systematic search of PubMed and Embase for studies that compared survival outcomes in GEP-NETs patients with LM who underwent PTR versus those who did not. Pooled effects are reported as hazard ratios (HR) with 95% confidence intervals (CI). We also conducted sensitivity analyses to evaluate the robustness of the findings. Results: Of 1525 screened articles, 11 studies met inclusion criteria, comprising 4185 patients who underwent resection. PTR was associated with improved overall survival compared with non-resection (HR = 0.48, 95% CI: 0.43-0.55). Sensitivity analyses, performed by sequentially excluding individual studies, did not materially change the result. Conclusion: PTR is associated with increased survival among GEP-NETs patients presenting with LM; however, decisions should be individualized based on patient and tumor characteristics.