Hepatic resection for neuroendocrine tumors should be considered for cytoreduction in addi tion to complete remission. Cytoreduction allows for both symptom control and debulking of slow growing tumors for which chemotherapy is ineffective. Patients with untreated hepatic metastases reveal a 20-40% 5-year survival, with a median survival of 2-4 years. Multiple retrospective series suggest a survival benefit to hepatic resection, however, all of these studies are retrospective and have a significant selection bias. Musunuru et al compared patients undergoing medical treatment, hepatic artery emobilization and resection.4 Patients undergoing resection had a significantly longer survival of 83% at three years. Although the difference in overall volume of disease in the liver was not statistically different between the groups, patients undergoing medical treatment and hepatic artery embolization were more likely to have bilobar disease and a higher number of hepatic lesions. Touzios et al compared patients with similar hepatic burdens who underwent non-aggressive treatment, hepatic resection and embolization in addition to resection.11 Patients had similar burdens of disease in terms of the percent liver involved, bilobar disease and mean tumor size. The non-aggressive group was more likely to have the primary in place and to receive systemic chemotherapy. There was a significant difference in symptom control (42% vs 91%) and 5-year survival (25% vs 62%).