Cystic pancreatic neoplasms comprise a heterogeneous group of pathologic entities. Mucinous cystic tumors and serous cystadenomas account for more than 75% of reported cases. While serous cystadenomas are almost uniformly benign, mucinous cystic tumors all have malignant potential and must be treated as such. While both clinical and biochemical features can distinguish among the various cystic pancreatic lesions, surgical resection is often required for both definitive diagnosis and treatment. When surgery is performed, benign lesions should be treated with pancreatic parenchymal sparing procedures if anatomy permits. Standard surgical oncologic principles should be employed when treating indeterminate or malignant lesions.