Surgery for Gastroenteropancreatic Neuroendocrine Tumors with Synchronous Liver Metastasis

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

doi:10.1245/s10434-025-18409-z

Surgery for Gastroenteropancreatic Neuroendocrine Tumors with Synchronous Liver Metastasis

Ann Surg Oncol. 2026 Jan 12. doi: 10.1245/s10434-025-18409-z. Online ahead of print.

Affiliations

¹ Surgical Oncology Program, National Cancer Institute/National Institutes of Health, Bethesda, MD, USA.
² Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
³ Department of Surgery, MedStar Health, Georgetown/Washington Hospital Center, Washington, D.C., USA.
⁴ Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, NV, USA.
⁵ Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
⁶ Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
⁷ Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
⁸ Surgical Oncology Program, National Cancer Institute/National Institutes of Health, Bethesda, MD, USA. jonathan.hernandez@nih.gov.

PMID: 41526627
DOI: 10.1245/s10434-025-18409-z

Abstract

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.

Keywords: Liver metastases; Pancreatic neuroendocrine tumor; Gastroenteropancreatic neuroendocrine tumor; Small bowel neuroendocrine tumor.