Introduction Benign and malignant pancreatic neuroendocrine tumors (PNET) are rare and long term outcomes are generally poor without surgical intervention. The aim of the study is to determine whether aggressive pancreatic resection is justifiable for patients with PNET. Methods All consecutive patients that had undergone major pancreatic resection for PNET from Jan 1997 to Jan 2005 were retrospectively reviewed and analyzed. Results There were 33 patients (16 M, 17 F) with mean age of 53 year old. Five patients had MEN I and 1 patient had von Hippel-Lindau syndrome. There were 20 benign (9 functional) and 13 malignant (6 functional) neoplasms. The mean tumor size was 4.2 cm with multiple tumors noted in 10 patients (33%). 8 patients (25%) had a pancreticoduodenectomy, 4 patients (12%) had extended distal pancreatectomy and 21 patients (63%) had a standard distal pancreatectomy. Regional lymph node involvement was present in 10 patients (30%) and 6 patients (18%) had liver metastases. 4 patients (12%) had resection of an adjacent organ due to disease extension. The median intra-operative blood loss was 500 ml. Perioperative morbidity was 36% (12 patients) and mortality was 3 % (1 patient). Symptomatic palliation was complete in 93% (14/15 patients) and partial in 1 patient due to unresectable hepatic disease. The median hospital stay was 11.5 days. The median disease free survival was 20 months for patients undergoing complete resection. After a median follow up of 36 months, disease progression and the survival rate in patients with malignancy was 75% (9/12 patients) and 58% (7/12 patients), respectively. There were no local recurrences. 4 patients had progression of their unresectable hepatic metastases. They were treated with chemoembolisation/infusion therapy and 2 patients subsequently developed bony metastases. Disease progression resulted in mortality in 5 patients (42%). 1 patient with metastatic insulinoma developed recurrent endocrine symptoms. New hepatic lesions developed in 4 patients, 2 were treated with partial hepatic resections, 1 with TACE and 1 with observation. The sole long term survivor after hepatic recurrence is disease free at 36 months following hepatic resection. Conclusions Aggressive pancreatic resection for PNET can be performed with low perioperative mortality and morbidity. Unlike available non-operative therapy this approach offers an excellent means of symptomatic palliation and local disease control. In malignant PNET metastatic recurrence is not uncommon and will usually require additional multimodality therapy. When possible an aggressive approach to PNET is justified to optimize palliation and survival