# 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

## TL;DR

Removing the primary tumor and liver metastases improves survival in patients with neuroendocrine tumors that have spread to the liver.

## Contribution

This study provides a meta-analysis showing that primary tumor resection improves survival in GEP-NETs with liver metastases.

## Key findings

- PTR was associated with improved overall survival (HR = 0.48, 95% CI: 0.43–0.55).
- Sensitivity analyses confirmed the robustness of the survival benefit from PTR.

## Abstract

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.

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.

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.

PTR is associated with increased survival among GEP-NETs patients presenting with LM; however, decisions should be individualized based on patient and tumor characteristics.