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OBJECTIVE: To identify trends in cystic neoplasms of the pancreas. DESIGN: Case series from a retrospective database. SETTING: Academic referral hospital. PATIENTS: Eight hundred and forty nine consecutive patients resected for cystic tumors of the pancreas over a 25-year period. MAIN OUTCOME MEASURES: Demographics, tumor type, and survival analysis performed in five time periods, between 1985 and 2010. RESULTS: Seventy four percent of patients were female and mean age was 63 years. The most common pathological diagnoses were IPMN (38%), serous cystadenoma (17%), mucinous cystic neoplasm (17%), and cystic neuroendocrine neoplasm (6%). There was a stepwise increase in the number of resections across time periods (67 between 1985-1990; 269 between 2006-2010), with a parallel increase in the proportion of incidentally-discovered lesions (30 to 66 %). Diagnosis of IPMN was very uncommon in the first two time periods but predominated in the last two (45 and 69%), and cystic neuroendocrine tumors, which constituted 2% of the cystic tumors in the first time-period, now comprise 8% of pancreatic cystic neoplasms. The proportion of malignant tumors decreased significantly over time (53.5% between 1985-1995; 14% between 2006-2010), probably reflecting earlier diagnosis and treatment of pre-malignant neoplasms. Although operative mortality was minimal (2/849, 0.25%), the post-operative complication rate was 37%. Five-year survival for all mucinous lesions was 87%. CONCLUSIONS: Cystic tumors of the pancreas are being diagnosed and treated with increasing frequency. At present, most are incidentally-discovered IPMNs.