<p>Pancreatic neuroendocrine tumors (pNETs) are characterized by significant spatial and temporal heterogeneity, exhibiting a wide spectrum of biological behaviors, histopathological features, and clinical presentations. The presence of liver metastases in pNETs is a critical prognostic factor that markedly alters the natural history of the disease and therapeutic outlook. Hepatic metastasis significantly influences treatment strategies, necessitating a multidisciplinary team (MDT) approach that integrates expertise from surgery, pathology, medical oncology, interventional radiology, and radiation oncology. Advances have been made in surgical resection, pharmacotherapy, interventional treatments, and radiotherapy. Evidence-based treatment paradigms tailored to different tumor grades and stages have been recommended by multiple specialty guidelines. This review summarizes recent progress in the field, covering topics such as the mechanisms underlying liver metastasis, advances in clinical research, controversies in surgical management, the role of neoadjuvant therapy prior to surgery, and options for non-surgical treatment modalities. It emphasizes the importance of regular MDT meetings to refine individualized treatment plans and to promptly address emerging challenges—such as treatment resistance and disease progression—with the ultimate goal of improving patient outcomes and quality of life.</p>