Gastroenteropancreatic neuroendocrine tumors account for 65%-75% of all neuroendocrine tumors, of which pancreatic neuroendocrine neoplasms (pNENs) account for 45% of the former. pNENs diagnosis and treatment have achieved rapid development in recent years, and qualitative and localized diagnosis has matured, enabling early detection and treatment of many pNENs. The diagnosis and treatment of pNENs have been rapidly developed in recent years, and qualitative and localized diagnosis has been matured, allowing early detection and treatment of many pNENs. However, pNENs is still a rare disease in China, and the level of diagnosis and treatment varies among regions, clinicians have insufficient knowledge of the disease, and it is difficult to accumulate experience in primary hospitals, so the phenomenon of misdiagnosis and omission is still very prominent. Currently, pNENs are considered to have malignant potential, among which the malignant rate of insulinoma is 10%, gastrinoma is >90%, pancreatic vasoactive hormone tumor is 75%, pancreatic hyperglycemic hormone tumor and growth inhibitory hormone tumor are both 50%, so the treatment of pNENs has risen to the height of tumor radical treatment. At the same time, pNENs progress relatively slowly and are sensitive to some drug treatments, so they should be resected if the tumor is resectable, and even palliative resection is considered to be beneficial to patients. In AJCC, the TNM stage of pNENs is the same as that of pancreatic adenocarcinoma. Regarding the current status of treatment of pNENs, there are some opinions as follows: it is generally believed that for limited stage pNENs, surgery is still the main treatment, whether functional or non-functional pNENs, regardless of the occurrence of metastasis, surgery is the only means to achieve the purpose of cure. However, there is little agreement on the indications for surgery. For pNENs larger than 50 px, the consensus is that surgery is required. The Chinese Expert Consensus on Gastroenteropancreatic Neuroendocrine Tumors considers insulinoma and nonfunctional pNENs less than 50 px to be considered for tumor enucleation or local resection, or distal pancreatectomy with preservation of the spleen, provided that the main pancreatic duct can be preserved intact (tumor distance from the pancreatic duct is greater than or equal to 3 mm). There are views1,2 that tumors less than 25 px in diameter can be followed up, but at the same time there are opposing views3 that even small non-functional tumors considered benign can exhibit malignant behavior. Regarding the need for regional lymphatic clearance of pNENs, previous clinical practice has not paid attention to the detection of lymph nodes in surgical specimens of pNENs, and the impact of lymph node metastasis on the prognosis of pNENs, with conflicting findings from different studies. Several studies4 have shown that pNENs should be treated like adenocarcinoma and that surgery should follow the “radical” principle, i.e., complete resection of the tumor (En Bloc) with appropriate regional lymph node dissection.5 In a retrospective analysis of 3851 pNENs in the SEER database, Bilimoria et al.5 concluded that lymph node metastasis was not associated with prognosis. concluded that lymph node metastasis was not associated with prognosis. The latest 2014 NCCN guidelines6,7 suggest that lymph node dissection should be performed for tumors larger than 50 px, while tumors between 1 and 50 px are considered to have a small likelihood (7%-26%) of lymph node metastasis, and therefore regional lymph node dissection may be considered. In fact, clinically, about 50% of patients are already locally advanced or have metastases at the time of diagnosis. For tumors that have metastasized, although radical surgery is not possible, surgical resection of primary and metastatic foci and lymph node dissection should be performed as much as possible to reduce tumor load, alleviate local symptoms caused by tumors and hormone-induced related clinical symptoms, and improve patients’ quality of survival, which is not the same as pancreatic cancer in advanced stages. There is also a difference between advocating palliative resection in advanced pancreatic cancer. For the surgical treatment of pNENs, on the one hand, we emphasize extended radical treatment, but on the other hand, we advocate a “small” resection that preserves the function of the pancreas as much as possible, on the one hand, we consider it as a “malignant” potential, but on the other hand, we suggest that pNENs smaller than 25px can be followed up. On the one hand, it is considered as “malignant” potential, and on the other hand, it is recommended that pNENs smaller than 25px can be followed up, which is contradictory in itself; for pNENs smaller than 50px, how to operate is also controversial.