Background: Pancreatic solid pseudopapillary neoplasms (SPNs) are low-grade malignant tumors of the pancreas. Organ-preserving surgery is being increasingly performed for these tumors, although there is little evidence to support its use. This retrospective multicenter study aimed to determine the clinicopathologic characteristics of pancreatic SPNs in Central and Western China and to determine the efficacy of organ-preserving surgery.Methods: The clinicopathologic, treatment and follow-up data of 227 pancreatic SPN patients treated between July 2003 and December 2016 at 5 tertiary care centers were retrospectively reviewed.Results: Among the 227 patients (38 males, 189 females; mean age 33.30 +/- 12.70 years), only 72 (31.7%) had symptoms. The mean tumor size was 55.08 +/- 29.56 mm. Adjacent organ/lymphovascular invasion was present in 16 (7.1%) patients and distant metastasis in 3 (1.3%) patients; no patient had spread to distant lymph nodes. Surgery included organ-preserving surgery in 108 (47.6%) patients, classic surgery in 115 (50.7%) patients, and palliative surgery in 4 (1.8%) patients. Tumor recurrence was seen in 8 (3.6%) patients. Cox regression analysis showed positive surgical margin (P < .01) and metastasis (P = .03) to be independent predictors of recurrence. Tumor characteristics were comparable between patients receiving organ-preserving surgery and classic surgery. The risk of recurrence was also similar in both groups (P = .72).Conclusions: Organ-preserving surgery appears to be an effective procedure for the treatment of pancreatic SPNs. Resection surgery should aim for negative surgical margins.