Considerations guiding surgical resection of functional PNETs fall into two catego­ries: oncologic and endocrine. Oncologic considerations depend on balancing the long-term benets of resection with the risks of surgery; these considerations depend on tumor-specic factors that inform the risk of metastatic spread (pheno­type, stage, grade, size, location), anatomy, and patient-specic factors including age and comorbidities. This is tempered in some cases of genetic predisposition to tumors where recurrent or multifocal disease diminishes the benets of local resec­tion (see below). In many patients with localized disease, complete resection is curative. In patients with locoregional or metastatic disease, debulking surgery may prolong life and provide local control of the tumor in anatomic areas that may be compromised by a bulky lesion, e.g., porta hepatis, duodenum, and root of the mes­entery [6–8]. Pancreatic surgery carries signicant risks of morbidity and complica­tion, and oncologic goals must be weighed against the functional status of the patient and the perceived benet of resecting tumors that may have an indo­lent course.