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Context Liver metastases have often existed in patients who have pancreatic neuroendocrine tumors (pNETs) at the time ofdiagnosis. In the management of patients of pNETs with unresectable liver metastases, the clinical efficacy of surgery toprimary pancreatic tumor has been controversial. We presented four patients who were treated with resection of primarypancreatic tumor, trans-arterial hepatic treatment and systemic therapies. We reviewed literatures and discussed about roleof resection of primary pancreatic tumor in the multidisciplinary treatment. Methods We retrieved medical records of patients who had been histopathologically diagnosed as pNETs at our institution between April 2000 and March 2006, andfound 4 patients who had pNETs with unresectable synchronous liver metastases and no extrahepatic metastases. Allpatients received resection of primary tumor. Patients’ demographics, pathology, treatment, short- and long-term outcomewere examined. Results In short-term outcome analysis, delayed gastric emptying was developed in one patient whoreceived pancreaticoduodenectomy. There were no other significant postoperative complications. As for long-term outcome,two patients who received distal pancreatectomy, sequential trans-arterial treatments and systemic therapies could survivefor long time relatively. They died 92 and 73 months after the first treatment, respectively. One patient who received distalpancreatectomy and trans-arterial treatment died from unrelated disease 14 months after the first treatment. Anotherpatient who received preoperative trans-arterial treatments and pancreaticoduodenectomy rejected postoperative transarterial treatment, was treated with systemic therapies and died 37 months after the initial treatment. Conclusions Resection of primary pNETs would be considered as an optional treatment for the selected patients who had unresectablesynchronous liver metastases in the process of the multidisciplinary approach.