Mapping the Evidence for Surgical Care of Gastro-Entero-Pancreatic Neuroendocrine Tumors (GEP-NETs): A Scoping Review

Surgical management remains the cornerstone in the management of gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs), yet surgical indications and procedures are often inconsistent. To inform the development of a research agenda to strengthen the evidence in NETs surgical care, we conducted a scoping review to map the existing literature on surgery for gastro-entero-pancreatic (GEP) NETs.

The scoping review was conducted following the expanded framework of Arksey and O'Malley. A literature search was run on MEDLINE, Embase, and Scopus in October 2024 for studies published since 2000 reporting on any surgical intervention, performed under general or loco-regional anesthesia on adults with GEP-NETs at any stage.

Among the 10,000 studies screened, 260 were included. Publications included were mostly reviews covering a broad range of topics. Of the 120 original investigations, 96.7% were retrospective cohort studies and 43% were single center. There were only four prospective cohort studies. Of all publications included, the most common topics were observation of small pancreatic NETs, treatment of liver metastases, safety of minimally invasive surgery, and prognostication. Of original investigations, the majority compared surgical approaches, followed by examination of lymph node harvest and defining size cutoff for observation of pancreatic NETs.

This scoping review highlights limitations and gaps in the evidence supporting surgical care for GEP-NETs. Very few original investigations report prospective or multi-institutional data, and examination of pancreatic NETs dominate the literature. Future research should prioritize prospective, multi-institutional studies, stage- and primary-site-specific analyses, and interventional trials evaluating surgery relative to other therapies.