Epidemiology, classification and clinical burden of pancreatic cystic lesions

Pancreatic cystic neoplasms (PCNs), once considered rare, are increasingly detected due to advances in imaging, with prevalence estimates ranging from 13 % to nearly 50 % and rising with age. They comprise a heterogeneous group, including intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), solid pseudopapillary neoplasms (SPNs), cystic neuroendocrine tumors, and pseudocysts. Their biological behavior differs substantially: SCNs and pseudocysts are usually benign, MCNs and IPMNs may progress to cancer, and SPNs generally require resection. Accurate classification is therefore essential, as misdiagnosis may lead to overtreatment with surgical complications or undertreatment with missed malignant transformation. Epidemiological studies link PCNs to age, metabolic syndrome, diabetes, and smoking, with emerging associations to autoimmune pancreatitis, chronic kidney disease, and fatty pancreas. IPMNs are the most frequent subtype, with risk of progression influenced by cyst size, multifocality, obesity, and tobacco exposure. Management requires balancing oncological risk with patient-specific factors such as comorbidities, age, and life expectancy. While surgery eliminates malignant potential, it carries relevant morbidity and mortality. Conversely, long-term surveillance imposes psychological stress, healthcare resource use, and financial costs. As their incidence grows, PCNs have become a major clinical and healthcare challenge. Cost-effectiveness analyses favor risk-adapted surveillance over systematic resection, emphasizing the importance of personalized strategies that reduce overtreatment while ensuring timely intervention for high-risk lesions.