Surgical Management of Pancreatic Cystic Neoplasms (PCNs)

Pancreatic cystic neoplasms (PCNs) are being identified more often today, largely because of the widespread use of high-quality imaging. These cysts range from harmless serous lesions to mucinous and solid tumors that carry a real risk of cancer. Because of this wide spectrum, recognizing the exact subtype is crucial for choosing the right management approach. This chapter offers a clear and practical overview of how each major type of PCN is surgically managed—IPMNs, MCNs, SCNs, and SPNs. It brings together the latest international guidelines, current evidence, and real-world decision-making strategies. Readers will learn why MCNs nearly always require removal, why IPMNs demand a careful balance between surveillance and timely surgery, why most SCNs can be safely observed, and why complete resection cures the vast majority of SPNs. The chapter also highlights how minimally invasive, robotic, and parenchyma-preserving operations are transforming surgical practice. Key challenges—such as interpreting frozen sections and planning postoperative follow-up—are explained in a practical manner. Emerging innovations like radiomics, molecular profiling, artificial intelligence, and liquid biopsy are introduced as tools that will soon reshape how surgeons assess risk and individualize treatment. As diagnostic tools advance, surgical strategies are becoming more tailored, less invasive, and more focused on preserving pancreatic function without compromising cancer control.