Background: The efficacy of palliative primary tumor resection (PTR) in improving prognosis for patients with unresectable metastatic colorectal NENs has not been fully explored.Methods: We performed one retrospective cohort study and recruited 68 patients with metastatic colorectal NENs from two Chinese medical centers. The clinicopathological manifestation data were carefully collected, and the survival outcomes were compared between the two groups.Results: A total of 32 patients received PTR, and the other 36 patients did not. The median progression-free survival (PFS) and overall survival (OS) times were 4 and 20 months in the cohort, respectively. For patients who received no PTR, the median OS was 31 months, and the 1-year OS rate and 3-year OS rate were 61% and 42.5%, respectively. For patients who received PTR, the median OS was 24 months, and the 1-year OS rate and 3-year OS rate were 70.5% and 27.9%, respectively. However, the Kaplan–Meier survival curves and log-rank test demonstrated no significant survival difference between the two groups (P=0.585). Palliative PTR was also not confirmed as a prognostic factor in subsequent univariable and multivariable analyses.Conclusions: Palliative PTR may not offer survival benefits for patients with unresectable metastatic colorectal NENs.