A patient with advanced pancreatic neuroendocrine carcinoma and liver metastases underwent explorative laparotomy, which demonstrated local infiltration of the mesenteric root and superior mesenteric vein congestion. After 3 courses of peptide receptor radionuclide therapy (PRRT) with Lu-177-DOTA-octreotate, there was significant downsizing with partial response. A Whipple procedure was than successfully performed. No intra- or postoperative impairments to surgery or healing related to PRRT were noted. Histopathology and postoperative imaging confirmed R(0) resection. The patient has been in complete local remission for 22 months. This case demonstrates the potential of preoperative PRRT to improve resectability of initially inoperable pancreatic endocrine tumors.