Decreasing utilization of surgical interventions amongst patients with pancreatic neuroendocrine tumor with liver metastases.

Background: Since 2013, North American Neuroendocrine Tumor Society (NANETS) consensus-guidelines have endorsed consideration of surgical intervention for pancreatic- neuroendocrine tumors (PNET) with liver metastases.
Methods: Patients with non-functional PNET with liver only metastases from 2010 to 2019 were identified from the National Cancer Database.
Results: 34.7% underwent surgical intervention (13% PNET resection, 2.1% surgical management of liver metastases (SMLM), 19.5% PNET resection ​+ ​SMLM). In multivariable analysis, government insurance, year of diagnosis>2013, increasing primary tumor size were associated with lower rate of surgical intervention. Receiving treatment at an academic center (OR 3.59, 95%CI 1.81-7.11; P ​< ​0.001) or integrated cancer network (OR 3.21, 95%CI 1.57-6.54; P ​= ​0.001) was associated with a higher rate of surgical intervention. The overall rate of surgical intervention decreased from 45.7% in 2010 to 23.0% in 2019.
Conclusion: Despite guideline recommendations and the suggested survival benefits, only one-third of patients underwent surgical intervention, potentially influenced by the rising utilization of systemic therapy in the past decade.
Competing Interests: Declaration of competing interest All authors declare no conflicts of interest to disclose regarding the research, publication, or any other activities associated with this project. The authors have no financial, personal, or professional relationships that could be perceived as potentially influencing the integrity or impartiality of their work.
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