title: Curative versus palliative surgical resection of liver metastases in patients with neuroendocrine tumors: a meta-analysis of observational studies.
abstract: BACKGROUND
  The role of surgical therapy in patients with liver metastases from neuroendocrine tumors (NETs) is unclear. In this study, the results obtained with curative or palliative resection, by reviewing recent literature and performing a meta-analysis, were examined.
  
  
  METHODS
  A systematic review and meta-analysis of observational studies published between January 1990 and October 2013 were performed. Studies that evaluated the different survival between patients treated by curative or palliative surgical resection of hepatic metastases from NETs were considered. The collected studies were evaluated for heterogeneity, publication bias, and quality. To calculate the pooled hazard ratio (HR) estimate and the 95% confidence interval (95% CI), a fixed-effects model was applied.
  
  
  RESULTS
  After the literature search, 2,546 studies were found and, among 38 potentially eligible studies, 3 were considered. We did not find a significant longer survival in patients treated with curative surgical resection of hepatic metastases when compared to palliative hepatic resection HR 0.40 (95% CI: 0.14-1.11). In one study, palliative resection of hepatic metastases significantly increased survival when compared to embolization.
  
  
  CONCLUSIONS
  Curative and also palliative surgery of NETs liver metastases may improve survival outcome. However, further randomized clinical trials are needed to elucidate this argument.
authors.affiliation: 1 Department of Surgery, 2 University of Udine, AOU "Santa Maria della Misericordia", Udine, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bacchetti
authors.affiliation: 1 Department of Surgery, 2 University of Udine, AOU "Santa Maria della Misericordia", Udine, Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Pasqual
authors.affiliation: 1 Department of Surgery, 2 University of Udine, AOU "Santa Maria della Misericordia", Udine, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Bertozzi
authors.affiliation: 1 Department of Surgery, 2 University of Udine, AOU "Santa Maria della Misericordia", Udine, Italy.
authors.forename: Ambrogio P
authors.initials: AP
authors.lastname: Londero
authors.affiliation: 1 Department of Surgery, 2 University of Udine, AOU "Santa Maria della Misericordia", Udine, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
keywords: Liver metastases; curative surgery; meta-analysis; neuroendocrine tumors (NETs); overall survival; palliative surgery