Comprehensive Management of Serous Cystic Neoplasm of the Pancreas

The widespread use of high-resolution cross-sectional imaging and the progressive aging of the population have led to a marked increase in the detection of pancreatic cystic lesions (PCLs), the majority of which are detected incidentally. These lesions encompass a heterogeneous spectrum ranging from benign, premalignant, and malignant, posing significant diagnostic and management challenges. Serous cystic neoplasms (SCNs) represent the most common benign PCLs predominantly detected in older women, frequent involvement of the pancreatic body and tail, and an indolent clinical course with a very low risk of malignant transformation. Most SCNs remain asymptomatic and can be safely managed conservatively once an accurate diagnosis is established. However, differentiating SCNs from mucinous and malignant cystic neoplasms remains a critical challenge, as management strategies differ substantially. Diagnostic uncertainty often necessitates a nuanced approach that balances the risks of unnecessary surgical intervention against the potential consequences of missed malignancy. This chapter provides a comprehensive and up-to-date review of serous cystic neoplasms, focusing on their epidemiology, pathogenesis, clinical presentation, and natural history. It critically discusses current diagnostic strategies, including advanced imaging modalities and adjunctive tools, outlines surgical and nonsurgical management options, and highlights emerging developments in diagnostics and therapeutics.