Postoperative Outcomes and Strategic Refinement in Intraductal Papillary Mucinous Neoplasm Management: A Single Academic Cancer Center Experience

Background/Aim: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a precursor lesion with variable malignant potential. Due to its heterogeneity, optimal treatment strategies remain controversial, especially regarding surgical resection and surveillance indications. We reviewed our institutional outcomes to reassess the current postoperative strategy and refine management guidelines. Patients and Methods: This study retrospectively and consecutively analyzed the data of 49 IPMN patients who underwent pancreatectomy at an academic institution from 2015 to May 2025. Results: Diagnostic mismatch between preoperative and final pathological findings was observed in 39% of cases, with overdiagnosis (downgrade group) being more common than underdiagnosis. Overdiagnosed cases were significantly associated with main pancreatic duct dilation (>5 mm) (p=0.012) and elevated amylase levels (p=0.031), while the only upgraded case involved invasive carcinoma with mural nodule and Sonazoid enhancement. Histological grade strongly influenced prognosis: Patients with adenoma or carcinoma in situ showed favorable outcomes (5-year OS ≥89%), whereas those with invasive IPMN had markedly worse survival (5-year OS 36%; p