How do you manage a duodenal somatostatinoma metastatic to liver?

These should be managed like metastatic pancreatic NETs.

The key is a careful evaluation, ideally in a multi-D setting, to determine if resection of the primary and mets is feasible. If not, the initial approach should be somatostatin analogs. PRRT certainly has activity in SSTR-positive disease and has been shown to be very effective in controlling functional syndromes.

The North American Neuroendocrine Tumor Society (NANETS) has published guidelines on the management of pancreatic NETs but those guidelines can also be applied to duodenal NETs.

NANETS pNETS Surgical Guidelines

NANETS pNETs Medical Guidelines