Current controversies in pancreatic cystic neoplasms

Pancreatic cystic neoplasms are a growing clinical challenge. They are incidentally discovered with increased frequency. The evaluation and management have evolved over time with increasing need to establish the correct type of cystic neoplasm and understand the unique natural history of each subtype. This review highlights this evolving strategy and an approach to management where treatment is guided by symptoms and features worrisome for high-risk of developing an invasive neoplasm. A thoughtful approach should be taken for an asymptomatic patient where resection needs to show a clear advantage to prevent cancer.