Surgical interventions for mucinous cystic neoplasms (MCN) should be more selective based on updated risk factors.

• The pooled rate of high-grade dysplasia (HGD) or invasive carcinoma (IC) in resected MCNs is just 17%.
• Cyst size is crucial: a threshold of 65 mm best differentiates high-risk from low-risk lesions.
• Key risk factors linked to HGD/IC include elevated CA 19-9 levels, mural nodules, and cyst wall thickening.

Surgeons should adopt a refined approach, focusing on cyst size and specific biomarkers to optimize patient outcomes and reduce unnecessary surgeries.