Gong J, Gao BJ, Lei ZH. Survival benefit of primary tumor resection in pancreatic neuroendocrine tumors with unresectable liver metastases: A meta-analysis. World J Gastrointest Surg 2025; 17(9): 107966 [DOI: 10.4240/wjgs.v17.i9.107966]
Corresponding Author of This Article
Ze-Hua Lei, MD, Professor, Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, No. 238 Baita Street, Leshan 614000, Sichuan Province, China. leitsehua@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 107966 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.107966
Survival benefit of primary tumor resection in pancreatic neuroendocrine tumors with unresectable liver metastases: A meta-analysis
Jie Gong, Ben-Jian Gao, Ze-Hua Lei
Jie Gong, Ze-Hua Lei, Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan 614000, Sichuan Province, China
Ben-Jian Gao, Department of General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Co-first authors: Jie Gong and Ben-Jian Gao.
Author contributions: Gong J and Gao BJ contributed equally to this work as co-first authors; Gong J conducted the literature search, performed data extraction and statistical analysis, and drafted the manuscript; Gao BJ contributed to study design, data interpretation, and critical revision of the manuscript; Lei ZH conceived and supervised the study, provided clinical expertise, and finalized the manuscript. All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ze-Hua Lei, MD, Professor, Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, No. 238 Baita Street, Leshan 614000, Sichuan Province, China. leitsehua@126.com
Received: April 2, 2025 Revised: June 25, 2025 Accepted: July 31, 2025 Published online: September 27, 2025 Processing time: 176 Days and 2.5 Hours
Abstract
BACKGROUND
Pancreatic neuroendocrine tumors (PNETs) are rare malignancies frequently associated with liver metastases (LM). The benefit of primary tumor resection (PTR) in patients with unresectable LM remains controversial. This study evaluates the impact of PTR on overall survival (OS) and tumor grading by integrating evidence from a systematic review, meta-analysis, and Surveillance, Epidemiology, and End Results (SEER) database analysis.
AIM
To evaluate the survival benefits of PTR in patients with PNETs and LM.
METHODS
This study was conducted in accordance with the PRISMA guidelines. A systematic literature search and meta-analysis were performed using five databases: PubMed, Web of Science, EMBASE, Cochrane Library, and CNKI, with records included up to February 2025. A total of 16 studies (n = 8761; including 1 prospective and 15 retrospective studies) were included. A random-effects model was applied to pool hazard ratios for OS and odds ratios for tumor grading, with heterogeneity assessed by the I2 statistic. Risk of bias was evaluated using the ROBINS-I tool. In addition, an independent analysis based on the SEER database (n = 791) was conducted using Kaplan-Meier survival curves and log-rank tests.
RESULTS
Meta-analysis results revealed that PTR significantly improved OS in patients with PNETs and LM (hazard ratio = -1.10, 95% confidence interval: -1.43 to -0.71, P < 0.0001). Subgroup analyses showed that neither study design (prospective vs. retrospective) nor sample size (< 400 vs ≥ 400) significantly influenced the survival benefit. In terms of tumor grading, no statistically significant difference was observed between the surgical and non-surgical groups (odds ratio = 1.60, 95% confidence interval: 0.70-3.63, P = 0.26). Independent analysis of the SEER database (n = 791) further confirmed the survival advantage of PTR across different tumor differentiation levels, with significant differences in OS between surgical and non-surgical groups (P < 0.05).
CONCLUSION
PTR significantly improves OS in PNET patients with LM. However, its effect on tumor grading remains unclear, warranting further prospective studies to refine surgical strategies for this population.
Core Tip: This study comprehensively evaluates the impact of primary tumor resection (PTR) on survival in patients with pancreatic neuroendocrine tumors and unresectable liver metastases. Our meta-analysis, involving 16 studies and 8761 patients, demonstrates that PTR significantly improves overall survival. Analysis of the Surveillance, Epidemiology, and End Results database further supports these findings, showing consistent survival benefits across different tumor differentiation levels. However, PTR’s effect on tumor grading remains unclear, highlighting the need for further large-scale prospective studies to refine surgical approaches for this patient population.
