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 thorn 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 1/4 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.