Surgery does not have a role in all pancreatic neuroendocrine tumors

Background The diagnosis of small, non-functioning pancreatic neuroendocrine tumors (pNETs) has increased due to the widespread use of abdominal imaging. However, pancreatic surgery carries significant risks of morbidity and mortality, prompting interest in non-operative management for biologically favorable, small pNETs. Aim To evaluate the long-term outcomes of patients with small, non-functioning pNETs (< 2 cm, Ki67 < 5%, no lymph node involvement or metastasis) managed non-operatively and compare them to outcomes of similar patients who underwent surgical resection. Methods This retrospective cohort study at a tertiary referral center compared surgery and surveillance in small non-functioning pNETs (≤ 2 cm, asymptomatic, well-differentiated, grade 1–2, Ki-67 < 5%, no nodal/distant disease). Patients diagnosed 2007–2023 with ≥ 24 months follow-up were analyzed. Groups were compared for diagnostics, metastasis, survival, and recurrence using descriptive statistics. The study followed STROBE guidelines and was approved by the xxx University, xxx Faculty of Medicine Ethics Committee Date: 28.11.2025, Decision No: 24, Protocol No: 2025/2002). Results Patients with < 2 cm, non-functioning, Ki67 < 5% pNETs and ≥ 24 months follow-up were included. Ten patients (median age: 50 years) underwent curative resection, with no recurrences during a mean follow-up of 107 months (range: 24–223 months). Nine patients (median age: 59 years) were managed non-operatively, with no tumor progression, NSE elevation, lymph node involvement, or distant metastasis during a mean follow-up of 47 months (range: 24–87 months). Conclusion Non-operative management of biologically favorable pNETs is a safe and effective alternative to surgery, sparing patients from the morbidity and mortality associated with pancreatic surgery.