Background and Aims Pancreatic serous cystic neoplasms (SCN) are benign diseases with an extremely low rate of malignant transformation. However, preoperative differentiation diagnosis of them is difficult, often requiring surgical resection to exclude malignant lesions. Improving the accuracy of preoperative diagnosis of pancreatic SCN can reduce unnecessary surgeries, thus mitigating surgical risks and complications. Therefore, this study was conducted to investigate the factors influencing the accurate diagnosis of pancreatic SCN through data analysis of pancreatic SCN patients who had undergone surgical resection.Methods The clinical data of 231 patients who underwent surgical resection for pancreatic cystic neoplasms and were pathologically confirmed between June 2018 and December 2020 in the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Naval Medical University were retrospectively collected. Among them, 104 cases (45.02%) were SCN, and 127 cases (54.98%) were non-SCN. Surgical procedures and postoperative complications of SCN and non-SCN patients were compared. The value of preoperative imaging examinations in SCN patients and factors interfering with preoperative correct diagnosis were analyzed.Results Among the 104 SCN patients, 62 cases (59.62%) were incidentally found during health maintenance examination, and 77 cases (74.04%) had tumors located in the body or tail of the pancreas. After operation, biochemical leak occurred in 55 cases, grade B pancreatic fistula occurred in 3 cases, grade A/B gastric emptying disorder occurred in 8 cases, grade C gastric emptying disorder occurred in 3 cases, and postoperative bleeding occurred in 1 case. Among the 127 non-SCN patients, 83 cases (65.35%) were incidentally found during health maintenance examination, and 103 cases (81.10%) had tumors located in the body or tail of the pancreas. After operation, biochemical leak occurred in 51 cases, grade B pancreatic fistula occurred in 1 case, grade A/B gastric emptying disorder occurred in 11 cases, grade C gastric emptying disorder occurred in 3 cases, and postoperative bleeding occurred in 1 case. There was no statistically significant difference in surgical methods and the incidence rates of severe postoperative complications (pancreatic fistula, gastric emptying disorder, and bleeding) between SCN and non-SCN patients (all P>0.05). The preoperative correct diagnosis rate of SCN was 32.69% (34 cases) in the 104 SCN patients, with correct diagnoses made by enhanced abdominal CT in 19 cases and enhanced pancreatic MRI in 15 cases. Among them, 12 cases showed cystic wall enhancement, 19 cases had internal septations, 5 cases had intracystic calcification, 6 cases had solid components, and 3 cases had main pancreatic duct dilation. Univariate analysis indicated that the type of auxiliary examination (P=0.012), cyst wall enhancement (P=0.065), presence of internal septations (P=0.002), presence of intracystic calcifications (P=0.077), presence of intracystic solid components (P=0.019), and main pancreatic duct dilation (P=0.094) were related to the correct diagnosis of SCNs. Multivariate analysis results showed that MRI examination (OR=3.619, 95% CI=1.274-10.729, P=0.016) and internal septations (OR=3.610, 95% CI=1.289-10.107, P=0.015) were independent factors affecting the correct diagnosis of SCN, and intracystic solid components (OR=0.334, 95% CI=0.107-1.039, P=0.058) and main pancreatic duct dilation (OR=0.025, 95% CI=0.184-0.042, P=0.025) were independent factors for exclusion diagnosis.Conclusion The preoperative correct diagnosis rate of pancreatic SCN is relatively low. Although surgical resection has a low incidence of severe postoperative complications, the benefits are limited. Combined with enhanced MRI examination of pancreas before operation, establishment of radiological deep learning model, and where feasible, the utilization of endoscopic ultrasound examinations can improve the ability to identify the imaging characteristics of SCN, thereby enhancing the accuracy of preoperative diagnosis and improving the rationality of surgical decision-making for pancreatic SCN.