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Introduction: Pancreatic neuroendocrine tumors (PancNET) are a comparatively rare, diverse group of neoplasms that account for 1-3% of all pancreatic tumors. While surgery is clearly the first line therapy for patients with disease amenable to resection at any stage of presentation, there are currently many surgical options. Due to both the diversity and rarity of the disease, there are limited data on different surgical outcomes and thus no clearly established guidelines supporting one surgical management option over another exists.
Objective: To identify differences in surgical outcomes of PancNET patients treated with various surgical approaches that may contribute to better management decisions in these patients.
Participants: Retrospective study of forty-four patients with histologically confirmed diagnosis of pancreatic neuroendocrine tumor, surgically evaluated at the University of California Irvine Medical Center (UCI-MC) between January 2003 and August of 2012. Surgical procedures included both traditional radical resections, such as a Whipple's procedure, total pancreatectomy and distal pancreatectomy with splenectomy, as well as organ sparing procedures, such as distal/segmental pancreatectomy without splenectomy and enucleation. These procedures were performed via open, laparoscopic, hand-assisted laparoscopic and robotic assisted approaches. AJCC criteria were used for tumor staging.
Results: Definitive surgical intervention were aborted in four patients with metastatic disease during laparoscopy due to deemed marginal surgical benefit and were excluded from further analysis. All other patients received definitive surgical intervention with margin free resection of local tumor. In one case of enucleation, patient was subsequently taken back for distal pancreatectomy with splenectomy after surgical pathology showed positive margins. There was one Stage IV patient with metastatic liver disease who received cytoreductive surgery along with regional adjuvant procedures for liver lesions. All 40 patients are still currently alive with median follow-up of 55.9 month from date of surgery. One patient who presented with Stage IIB disease recurred with hepatic disease at 4 months.
Conclusion: This data suggests achieving margin free resection of local tumor regardless of tumor stage, surgical method and approach leads to excellent 5 year survival rate with progression free disease.

Tumor Stage	Enucleation	Distal Pancreatectomy	Distal Pancreatectomy with Splenectomy	Total Pancreatectomy	Whipple
IA	2	3	13	0	3
IB	0	1	6	0	2
II	0	0	2	1	3
III	0	0	0	0	3
IV	0	0	1	0	0
Total	2	4	22	1	11