Overview The source of pancreatic neuroendocrine tumors is the islet endocrine cells. Depending on the clinical manifestations, pancreatic neuroendocrine tumors can be classified as functional or non-functional. Functional pancreatic neuroendocrine tumors include: insulinoma, gastrinoma, pancreatic glucagonoma or vasoactive intestinal peptide tumor, growth inhibitor tumor, etc. It is worth mentioning that although the prognosis of pNET is better than that of pancreatic cancer, current research reveals that all types of pancreatic neuroendocrine tumors have malignant potential, and their malignancy increases significantly once they metastasize. It is generally believed that pancreatic neuroendocrine tumors grow slowly. Recent studies have found that pancreatic neuroendocrine tumors are prone to distant metastases, and only 14% of them are confined to the pancreas. Local metastasis occurs in 22% of cases, and distant metastasis is as high as 64%. Diagnosis Serum CgA: a specific marker for pancreatic neuroendocrine tumors, with a sensitivity of about 70%. Conventional imaging: ultrasound, CT, MRI, the success rate of conventional imaging for diagnosis of <25px is less than 50%. Growth inhibitory receptor scan (SRS, this test is special, only a few hospitals have the relevant equipment); according to the majority of tumors expressing growth inhibitory receptor (SR) characteristics, SRS can scan pNET and metastases throughout the body in one scan, with economic and rapid and whole-body imaging characteristics. Ultrasound endoscopy: Combining conventional endoscopy with ultrasound, currently the most accurate method for anatomical localization of pancreatic tumors. Pathological diagnosis: including cytopathology and histopathology, which is the gold standard for confirming the diagnosis. Grading is required according to histology and proliferative activity, and complete pathological information plays an important role in determining tumor prognosis and formulating treatment plans. Treatment Surgical treatment is the first choice. For early to mid-stage tumors without metastasis, complete resection of the tumor and regional lymph nodes is the main means, and its main procedures include pancreaticoduodenectomy, pancreatic body and tail resection, local resection of the tumor, regional lymph node removal, and middle pancreatic resection. After surgery, follow-up or further treatment is used according to the patient's pathological stage and G classification. For patients who can undergo radical surgical resection, the 5-year survival rate can reach 80%-100%. Even tumor removal has a better outcome. The basic purpose of surgery is twofold: to eradicate the tumor or control its development; and to eliminate the symptoms of endocrine disorders caused by the tumor. The surgical resection rate is significantly higher than that of other types of pancreatic tumors. Due to the unique characteristics of pancreatic neuroendocrine tumors, most patients are diagnosed after the disease has progressed or even metastasized. Unlike conventional pancreatic cancer (median survival of 3-6 months after the occurrence of metastases), resection of the primary tumor and metastases as much as possible can achieve similar outcomes as in cases without metastases. For cases with extensive metastases that cannot be resected radically, if more than 90% of the lesions can be resected, active surgery should be performed to reduce the tumor load. Because for functional neuroendocrine tumors, the symptoms of endocrine disorder and the number of tumor cells are parallel, reducing the tumor load can help improve the quality of life and the effectiveness of chemotherapy.