Long-term Outcomes of Surgical Treatment for Pancreatic Neuroendocrine Neoplasm With Synchronous Hepatic Metastasis: A Multicenter Retrospective Cohort Study.

Objective: To evaluate surgical impact on the overall survival (OS) of pancreatic neuroendocrine neoplasm (pNEN) with synchronous hepatic metastases (sHMs).

Methods: A total of 163 pNEN-sHM patients were recruited from 3 institutions in China, who were categorized into 3 groups: no resection, resection of the primary lesion, and resection of both primary and hepatic lesions (PHR). Cox regression was employed to evaluate surgical impact on the OS.

Results: In the overall cohort analysis, PHR demonstrated a significant protective effect on OS (hazard ratio, 0.302; 95% confidence interval, 0.127-0.721; P = 0.007). Nevertheless, subgroup analysis revealed PHR conferred a survival advantage in patients with pancreatic neuroendocrine tumor (pNET) located on the pancreatic body/tail (bt-pNET-sHM) (hazard ratio, 0.287; 95% CI, 0.087-0.946; P = 0.040), whereas surgical treatment did not significantly impact survival in the subgroups of pancreatic neuroendocrine carcinoma-sHM or pancreatic head/neck pNET-sHM (hn-pNET-sHM).

Conclusions: In this study, the survival benefit of surgery was observed only in the bt-pNET-sHM subgroup. Considering the multifactorial nature of decision-making, surgical intervention for pNEN-sHM management should be approached with a careful and comprehensive assessment, to prevent excessive surgery strategies.