Cystic neoplasms of the pancreas have been recognized for almost 2 centuries, but the principles of management continue to evolve. Clinicians have a better understanding now of the diverse pathologies and behaviors of cystic neoplasms, and can characterize them more precisely into benign, malignant, and of uncertain potential in their manifestations. Treatment is dependent on accurate diagnosis and tailored to the potential aggressiveness of the lesion, the surgical fitness of the patient, and the probability of effecting long-term palliation or survival of the patient. In this article the authors review the classification based on the World Health Organization classification and the latest evidence-based literature of cystic neoplasms, and present their considerations for surgical management of the various lesions. A better understanding of the biologic potential of cystic neoplasms such as intraductal papillary mucinous neoplasms allows for a more patient-specific evidence-based management plan.