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Pancreatic neuroendocrine neoplasm (pNEN) is highly heterogeneous. Surgery is an important part of the comprehensive treatment for pNEN, however, the low incidence and strong heterogeneity of the disease retard the progress of surgical treatment. In terms of treatment concepts, the therapeutic strategy of surgery may transform from condition-orientated to prognosis-orientated treatment, and the evaluation of tumor characteristics relies more on morphology combined with molecular pathology. In addition, pNEN surgical treatment is becoming individualized, minimally invasive and delicate, and the timing of surgical intervention has extended to the entire disease period. Based on the research progresses in related fields, we analyzed the issues and challenges and discussed the evolution in the surgical treatment concepts of pNEN.