Available online 28 October 2025, 102062

In recent years, the detection of pancreatic cystic neoplasms (PCNs) has significantly increased, revealing a spectrum of biologically distinct entities with widely variable malignant potential. In this complex and heterogeneous landscape, a multidisciplinary approach is essential not only to correctly identify lesions at risk of malignancy, but also to determine their appropriate therapeutic window, avoiding unnecessary resections of benign cysts while ensuring timely intervention before progression to invasive cancer. Despite the development of several guidelines worldwide, the rates of misdiagnosis and overtreatment remain high across all cysts subtypes, raising concerns about the appropriateness of current surgical indications. This is particularly relevant in the context of incidental detection of small cysts due to the widespread use of cross-sectional imaging. This review critically examines the current evidence and limitations in the surgical management of PCNs, highlighting the need for improved risk stratification tools and more individualized treatment strategies.

Pancreatic cyst

Intraductal papillary mucinous neoplasm

Mucinous cystic neoplasm

Serous cystic neoplasm

Solid pseudopapillary neoplasm

Malignancy

Surgery

© 2025 The Authors. Published by Elsevier Ltd.