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Background: Symptomatic SCTs should be resected; but is unclear whether growth rate dictates that resection should be performed for size ≥4cm.Objective: To determine if the SCTs size and growth rate are indicators for resection. Methods: A retrospective review of a prospective database for Pancreatic Cyst Neoplasms Database (PCND) July 2000 through September 2010. Results: There were 800 patients identified in the PCND. Sixty one (7.6%) patients (40 non operated and 21 operated) were identified as serous cystic neoplasms. Of the non operated patients the median age was 71 years old and included 30 women (75%). At the time of diagnosis 38(97%) of the patients were asymptomatic and median cyst size was 2.77cm. A CT scan was performed as diagnostic test in 37(95%). An FNA was performed in 32(80%) of the patients, cellularity was benign in 38(96%) and atypical cells were present on 2(4%) of the patients. Median follow up was 3.05 years. After first year follow-up 1 patient became symptomatic and was resected. Cystic size ≥4cm were present in 10(25%) patients and <4cm in 30 (75%). The growth rate of the group was 0.35 cm per year. For cysts ≥4cm the growth rate was 0.24cm per year and in cysts <4cm the growth rate was 0.35cm per year (p=0.22).Twenty one patients underwent surgery. The median age was 68 years and 17 patients (80%) were female. Indications for surgery included presence of symptoms in 7(34%), mucin positive in 6(28%), increase in size 6(28%) and FNA with atypical cells in 2(10%). Surgical procedures performed included; distal pancreatectomy and splenectomy in 11(50%). whipple in 8(38%) and central pancreatectomy in 1(5%) and 1(5%) diagnostic laparotomy. A CT scan was performed as a diagnostic test in 19 (90%), median cystic size was 3.87cm. An FNA was performed in all of the patients, cellularity was benign in 19(90%) and atypical cells were present on 2(8%). Seventeen (80%) of the patients were follow for 1 year, 7(30%) for 2 years and 4 (20%) for 3 years before they were referred to the CCF. Cystic size ≥4cm was present in 5 (20%) patients and <4cm was present in 16(80%) of the patients. The growth rate as a group was 0.29cm per year. In cysts ≥4cm the growth rate was 0.78cm per year and in cysts <4cm the growth rate was 0.45cm per year (p=0.42). The growth rate in both surgical and non surgical patients were not statistical different ( p=0.23) and in patients with cysts <4cm (p=0.23). For cysts ≥4cm, patients operated had a statistically faster rate of growth compared to unoperated patients undergoing observation (p=0.011). Conclusions: Size of SCT alone is not an independent indication for resection. The indications for surgery are symptoms, and growth rate of approximate 1cm per year in cysts ≥4cm.