ObjectiveTo summarize the experience of diagnosis and treatment of pancreatic cystic neoplasms (PCN).MethodThe general information, imaging findings, preoperative blood biochemical indexes, tumor markers, operation related data, postoperative complications, and pathological results of patients with PCN confirmed by pathological examination in Affiliated Hospital of Xuzhou Medical University from January 1, 2014 to December 31, 2019 were retrospectively analyzed.ResultsAmong the 158 patients who underwent surgical resection, the male to female ratio was 1∶1.6, and the median age was 56.2 years (range 26 to 82 years). Serous cystadenoma (SCN) was the most common, accounting for 34.2% (n=54), followed by mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasm (IPMN), accounting for 26.6% (n=42) and 20.2% (n=32). The proportion of solid pseudopapillary tumor (SPT) was the smallest, which was 19.0% (n=30). The PCN malignant rate was 19.0% (n=30), with the highest malignant rate being IPMN (43.8%, n=14), and the lowest being SCN (3.7%, n=2). Patients with PCN malignant group had significantly higher serum CA19-9, CEA, CA125, and neutrophil/lymphocyte ratio (NLR) than those in the benign group（all P<0.05）. The preoperative diagnosis of PCN was ambiguous, and the rate of misdiagnosis was high. The correct diagnosis rate of accurate preoperative specific classification was only 31.6% (n=50), and the lowest SCN (14.8%, n=8). High CA19-9, high NLR value, tumor location in the head/neck of pancreas and enhanced solid component were independent predictors of malignant PCN (P<0.05).ConclusionImproving the preoperative diagnosis ability of PCN and accurately determining the PCN classification before operation are helpful for the standardized treatment of PCN.