Cystic Pancreatic Lesions Beyond the Guidelines: Can we Make an Evidence-Based Decision Whether to Resect or to Observe?

Pancreatic cystic neoplasms (PCNs) are no longer considered as rare entities because their prevalence in the general population ranges from 3–20%. They are usually asymptomatic, incidentally discovered, and diagnosed in the seventh decade of life. The main clinical concern with regard to PCNs is related to their risk of malignant progression, which is relevant for those PCNs that produce mucin. Since 2006, several sets of international guidelines have proposed algorithms for the management of PCNs, and these have been subsequently validated by several studies. Retrospective review of the literature shows that current treatment of PCNs remains unsatisfactory because the guidelines are based on a low level of evidence. However, the guidelines are able to correctly identify lesions that can be safely followed and, as occurs in vaccination campaigns, they are able to exercise a preventive effect in the general population