Background: There is still controversy about the best management of non-functioning pancreatic neuroendocrine tumours (NF-PNETs) ≤2cm. Methods: Retrospective study involving 102 surgically treated patients affected NF-PNETs. Patients having small tumours (≤2 CM) and those having large tumours (>2cm) were compared regarding demographics, clinical and pathological factors evaluating the risk of malignancy and relation to survival times such as overall survival (OS), disease free survival (DFS), years of life lost (YLL), years lost due to disability (YLD) and disability adjusted life years (DALY). Results: Small tumours were T3-4 in 11% and G2-3 in 36.6% of cases; lymph node and distant metastases were present in 31% and 8% of cases, respectively. When small and large tumours were compared, significant differences were found in relation to the presence of symptoms (P=0.012), tumour status (P>0.001), grading (P>0.001) and YLD (P=0.002). Multivariate analysis predicting malignancy and survival times showed that tumour size was related only to grading (P< 0.001). The YLL and DALY were influenced by age at diagnosis (P< 0.001) and presence of symptoms (P=0.039), while YLD was only related to grading (P=0.036). Conclusions: Tumour size did not seem to be reliable in predicting malignancy. In fact, small tumours could present nodal or distant metastases and could be G2-3 in a non-negligible percentage of cases. Secondly, their risk of malignancy and survival time are similar to larger tumours. Additional parameters should be considered in order to reduce YLL of patients with small tumors, such as age at diagnosis, presence of symptoms and grading.