Background: Neutrophil, monocyte and lymphocyte counts are important biomarkers of the tumor-induced systemic inflammatory response. A lower monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) is associated with a favorable prognosis for certain tumors. However, this association has not yet been demonstrated in resected pancreatic neuroendocrine tumors (PNETs). The aim of this study was to investigate the prognostic significance of MLR and NLR in patients with resectable PNETs with regards to overall survival (OS). Methods: Eligible patients undergoing surgery for PNETs between 2000 and 2016 were identified using a national multi-center cohort dataset. Their pre-operative neutrophil, monocyte and lymphocyte counts were imported and NLR and MLR were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut offs for NLR and MLR. Univariate analyses were used to compare patient factors and tumor characteristics in different groups. The difference in OS between high and low groups was explored with the use of Kaplan Meier curves and compared using log-rank tests. Results: A total of 635 patients were analyzed. Univariate analysis revealed that higher lymphocyte, low monocyte and low neutrophil counts were associated with improved OS (P = 0.0002, 0.014 and 0.011 respectively). The mean NLR and MLR level was 4.11 ± 0.219 and 0.4295 ± 0.0196, respectively. Lower NLR ( < 4) and lower MLR ( < 0.25) were significantly associated with improved OS (p < 0.001 & p < 0.0001). Median survival was 141 months in the low NLR group (n = 474) and 119 months in the high NLR group (n = 161). The median survival in the high MLR group (n = 464) was 120 months and has not been reached in the low MLR group (n = 171). On multivariate analysis, low MLR was independent predictor of improved OS when controlling for age, race and comorbidities (p < 0.001). Conclusions: For resectable PNETs, low pre-operative NLR and MLR levels are significantly associated with improved survival. NLRs and MLRs may serve as valuable markers to stratify PNET patients for subsequent therapies and clinical trial enrollment.