Neuroendocrine liver metastases are seeing better surgical outcomes as practices shift over the last two decades.

• In the later cohort (2009-2023), major hepatectomy dropped to 32.9%, compared to 60.0% (p < 0.001) in the earlier cohort (1998-2008).
• The 10-year overall survival improved significantly from 44.2% to 67.4% (p < 0.001).

Surgeons should consider parenchyma-sparing approaches and modern therapies for better patient outcomes.

• Local therapies and targeted agents were used more frequently in the later cohort after tumor progression.