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Background <p>Surgical management strategies for patients with synchronous liver metastases from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are controversial. This study sought to investigate survival outcomes associated with various resection strategies.</p> Methods <p>Patients with grade I or II primary NETs originating from the small-bowel (SBNETs) or pancreas (PNETs) with synchronous liver metastasis alone were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2019). Data were analyzed using chi-square testing, the Kaplan-Meier method with the log-rank test, and Cox proportional hazards regression models.</p> Results <p>Overall, 1448 patients were identified with grade I or II SBNETs (<i>n</i> = 859, 59%) or PNETs (<i>n</i> = 589, 41%) and synchronous liver metastases. The median follow-up period for the patients was 46 months (interquartile range [IQR], 29.0–72.0 months). Both primary resection and metastasectomy were more likely to be performed for SBNETs than for PNETs (41% vs 26%; <i>p</i> &lt; 0.001). Survival analysis showed that the patients receiving primary tumor resection and metastasectomy had a longer mean disease-specific survival (SBNETs, 97.0 months; PNETs, 71.6 months) than the patients who were surgical candidates but refused surgery (SBNETs, 73.5 months; PNETs, 56.5 months; <i>p</i> &lt; 0.01). In the multivariate analysis controlling for grade, primary resection with metastasectomy was associated with a survival advantage compared with no surgical intervention for both the patients with SBNETs (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.20–0.49; <i>p</i> = 0.01) and those with PNETs (HR, 0.22–0.47; 95% CI, 0.22–0.47; <i>p</i> &lt; 0.001).</p> Conclusions <p>This large population-level study suggests that the surgical management of patients who have primary SBNETs or PNETs with liver metastasis may be associated with a survival advantage. Surgeons should consider primary resection and metastasectomy (if safe and feasible) for this patient population.</p>

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Surgery for Gastroenteropancreatic Neuroendocrine Tumors with Synchronous Liver Metastasis

  • 期刊论文

  • 发表日期：

    2026年1月12日

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  • Tracey Pu,
  • Kenneth Luberice,
  • Shadin Ghabra,
  • Lindsay R. Friedman,
  • Kendra N. Coleman,
  • Carolina M. Larrain,
  • Yuri Lin,
  • Sarfraz R. Akmal,
  • Alyssa V. Eade,
  • Amber Leila Sarvestani,
  • Jeremy L. Davis,
  • Andrew M. Blakely,
  • Jaydira del Rivero,
  • Jonathan M. Hernandez

摘要

Background

Surgical management strategies for patients with synchronous liver metastases from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are controversial. This study sought to investigate survival outcomes associated with various resection strategies.

Methods

Patients with grade I or II primary NETs originating from the small-bowel (SBNETs) or pancreas (PNETs) with synchronous liver metastasis alone were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2019). Data were analyzed using chi-square testing, the Kaplan-Meier method with the log-rank test, and Cox proportional hazards regression models.

Results

Overall, 1448 patients were identified with grade I or II SBNETs (n = 859, 59%) or PNETs (n = 589, 41%) and synchronous liver metastases. The median follow-up period for the patients was 46 months (interquartile range [IQR], 29.0–72.0 months). Both primary resection and metastasectomy were more likely to be performed for SBNETs than for PNETs (41% vs 26%; p < 0.001). Survival analysis showed that the patients receiving primary tumor resection and metastasectomy had a longer mean disease-specific survival (SBNETs, 97.0 months; PNETs, 71.6 months) than the patients who were surgical candidates but refused surgery (SBNETs, 73.5 months; PNETs, 56.5 months; p < 0.01). In the multivariate analysis controlling for grade, primary resection with metastasectomy was associated with a survival advantage compared with no surgical intervention for both the patients with SBNETs (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.20–0.49; p = 0.01) and those with PNETs (HR, 0.22–0.47; 95% CI, 0.22–0.47; p < 0.001).

Conclusions

This large population-level study suggests that the surgical management of patients who have primary SBNETs or PNETs with liver metastasis may be associated with a survival advantage. Surgeons should consider primary resection and metastasectomy (if safe and feasible) for this patient population.