Abstract
BACKGROUND: Pancreatic cystic neoplasms (PCNs) are lesions with malignant potential that should be addressed differently according to clinical/morphological criteria, to ensure appropriate cancer prevention and while avoiding overtreatment. SUMMARY: Surgical resection remains the gold standard for high-risk PCNs (at least one high-risk stigmata, multiple "worrisome" features), whereas low-risk PCNs should be monitored through imaging to mitigate the non-negligible risk of postoperative complications. Endoscopic ultrasound (EUS)-guided therapies, such as injection or radiofrequency, may offer a minimally invasive and effective therapeutic option particularly for patients unfit for surgery, although their impact on prognostic (i.e., mortality) remains uncertain. KEY MESSAGES: This review summarizes the latest recommendations on surgical management and post-resection follow-up of PCNs and the potential role of EUS ablation in the treatment algorithm.