• Kurinchi Selvan Gurusamy, Viniyendra Pamecha, Dinesh Sharma, and Brian R Davidson.
• University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG. kurinchi2k@hotmail.com
• Cochrane Db Syst Rev. 2009 Jan 21 (1): CD007118.

BackgroundNeuroendocrine tumours are tumours of cells which possess secretory granules and originate from the neuroectoderm. While liver resection is generally advocated in patients with resectable liver alone metastases, the management of patients with liver metastases, which cannot be completely resected, is controversial.ObjectivesTo determine if cytoreductive surgery is better than other palliative treatments in patients with liver metastases from gastro-entero-pancreatic neuroendocrine tumours, which cannot be completely resected.Search StrategyWe searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS until July 2008 for identifying the randomised trials.Selection CriteriaOnly randomised clinical trials (irrespective of language, blinding, or publication status) comparing liver resection (alone or in combination with radiofrequency ablation or cryoablation) versus other palliative treatments (chemotherapy or hormone-therapy or immunotherapy) or no treatment in patients with liver metastases from neuroendocrine tumours, which cannot be completely resected, were considered for the review.Data Collection And AnalysisTwo authors independently identified trials for inclusion.Main ResultsWe were unable to identify any randomised clinical trial suitable for inclusion in this review.Authors' ConclusionsThe literature provides no evidence from randomised clinical trials in order to assess the role of cytoreductive surgery in non-resectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours. High-quality randomised clinical trials may become feasible to perform if their conduct and study design is thoroughly considered in all their practical and methodological aspects. Pilot randomised clinical trials, which can guide the study design of definitive randomised clinical trials, are necessary.

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