Patients with pancreatic neuroendocrine tumors (PNETs) and perineural invasion (PNI) face significantly worse outcomes post-surgery.

• PNI occurs in 24.4% of PNET patients and is linked to higher tumor grades and advanced disease stages.
• Patients with PNI have a median overall survival of 115.9 months, compared to no PNI patients whose median survival is not yet reached.
• Disease-free survival is also significantly reduced, with a median of 51.9 months for PNI patients versus 115.4 months for those without.

Assessing PNI should be routine for better patient prognostication and surgical decision-making.