INTRODUCTION: Pancreatic neuroendocrine tumors (pNET) exhibit a wide spectrum of clinical behavior, which makes their assessment and management quite challenging. The purpose of this study was to comprehensively assess the existing treatment landscape for patients with pNET. MATERIALS AND METHODS: The study was conducted with the support of the ESSO-EYSAC Research Academy in collaboration with the E-AHPBA. An online survey was distributed via email and social media to surgical networks across Europe and beyond (September 1-30, 2023). RESULTS: Overall, 155 complete responses were obtained. A specialized NET tumor board was present at the institutions of 94 (61 %) of the study participants. The most frequently applied guidelines were from ENETS (n = 97; 63 %), NCCN (n = 74; 48 %), and ESMO (n = 53; 34 %). For resectability, similar criteria as in pancreatic ductal adenocarcinoma were used by 111 (72 %) participants, even though 116 (75 %) participants believed that pNET/pNEC should have their own resectability criteria. Most respondents used somatostatin analogues (n = 126; 81 %) and chemotherapy (n = 85; 55 %) as neoadjuvant treatments, followed by molecularly targeted agents (n = 45; 29 %) and PRRT (n = 37; 24 %). Only 17 (11 %) participants agreed/strongly agreed that the management of pNET/pNEC is sufficiently addressed in surgical education programs. CONCLUSION: This international survey highlighted areas for improvement in the care of pNET, namely the lack of pNET-specific resectability criteria and educational programs addressing pNET management.

Amsterdam UMC Location University of Amsterdam Department of Surgery Amsterdam the Netherlands; Cancer Center Amsterdam the Netherlands

Department of General Visceral and Transplantation Surgery University Hospital Heidelberg Germany

Department of General Visceral and Vascular Surgery Salzkammergutklinikum Vöcklabruck Austria

Department of GI Surgery Ghent University Hospital and Cancer Research Institute Ghent Belgium

Department of Surgery Tomas Bata Regional Hospital Zlin Czech Republic

Department of Urology Icahn School of Medicine at Mount Sinai Hospitals New York United States

Division of Surgery and Oncology Department of Clinical Science Intervention and Technology Karolinska Institutet Karolinska University Hospital Stockholm Sweden; Department of Gastrointestinal Surgery HPB Unit Stavanger University Hospital Stavanger Norway; Department of Clinical Medicine University of Bergen Bergen Norway

Regional Hepato Pancreato Biliary Unit Manchester Royal Infirmary Manchester UK

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