Background: Neoplasms of pancreatic neuroendocrine or islet cell types encompass a wide variety of tumor types. The low incidence of malignant functional (F) or nonfunctional (NF) neuroendocrine islet cell tumors (ICTs) represents a challenge to precise posttherapeutic survival prediction.Methods: A pancreatic ICT data set was created from the SEER 1970-2004 database. Prognostic factors with survival impact, and relationships between surgical therapy and overall survival (OS) were analyzed with univariate and multivariate statistical methods.Results: Out of a cohort of 109,596 patients with a primary pancreatic malignancy, seven islet cell neoplasm histology groups with 2,350 individuals were identified. Histologic designations included carcinoid tumors (n=176), islet cell carcinomas (n=959), neuroendocrine (NE) carcinomas (n=1052), and malignant gastrinomas (n=68), insulinomas (n=47), glucagonomas (n=30), or VIPomas (n=18). The median age was 60 years (range: 20-95), 55% of patients were male, and the median tumor size was 4.8 cm (0.2-33). Sixty-five percent of tumors had distant metastases; nonmetastatic, localized disease differed based on tumor histology and ranged from gastrinomas (5%) to VIPomas (41%, p<0.0001). Resection frequency (mean: 31%) varied by tumor type; FICTs had a greater resection rate (43% vs. 30%, p=0.003); 30-day and 90-day mortality (%) were 6 and 11 after resection, compared to 19 and 27 without resection (p<0.0001). At a median follow up of 18 months (32 for survivors, range: 0-358), the median OS was 30 months, with group differences ranging from NE carcinomas (21) to VIPomas (96; p<0.0001). Diagnosis group and resection status had an obvious OS association: the median OS of resected versus unresected FICTs was 172 versus 37 months, while that of NFICTs was 113 versus 18 months (p<0.0001). Multivariate OS variables were: age, grade, surgical treatment, disease extent (all at p<0.0001), node involvement (p=0.0002), histopathologic group (p=0.004), marital status (p=0.008), and primary site (p=0.03). Compared to VIPomas, hazard ratios were: gastrinomas 1.4, insulinomas 1.8, glucagonomas 1.9, carcinoid tumors 1.6, islet cell carcinomas 2.1, and NE carcinomas (NOS) 2.1. There was no significant OS impact by gender, ethnicity, tumor size, or radiation therapy.Conclusions: When controlled for other established prognostic parameters, the histopathologic subtype assignment of pancreatic ICTs significantly affects survival prediction. Resective local treatment is associated with superior survival for all tumor types and remains the standard of care.