Achieving a textbook outcome in pancreatic neuroendocrine tumor surgeries significantly predicts better long-term survival.

• 64.1% of patients achieved a textbook outcome, correlating to higher 5-year disease-free survival (73% vs. 67%; p = 0.025) and overall survival (88% vs. 78%; p < 0.001).
• Major complications occurred in 30.9% of cases, with an in-hospital mortality of 2.6%.

Consider patient factors: older age, higher BMI, ASA ≥ III, and longer surgical times increase the risk of non-textbook outcomes, impacting decision-making.

• Organ-sparing procedures had a higher textbook outcome rate (74.8% vs. 61.6%; p = 0.008).