For a metastatic neuroendocrine tumor patient who has experienced prolonged progression free survival, how would you approach surgical debulking?   

Does the advent of more effective therapies like peptide receptor radioligand therapy (PRRT) and capecitabine and temozolomide (CAPTEM) dampen enthusiasm for debulking procedures? How aggressively should a patient be debulked? 

Answer from: Medical Oncologist at Academic Institution