Mixed-type intraductal papillary mucinous neoplasms (IPMNs) have a lower malignancy risk than previously thought, affecting surgical decision-making.

• 46.5% of mixed-IPMNs showed malignancy, compared to 79.2% in main-duct and 33.9% in branch-duct IPMNs.
• In the absence of high-risk features, the malignancy rate for mixed-IPMNs dropped to 24.7%, similar to branch-duct IPMNs at 20.2%.

Consider patient selection carefully, as many mixed-IPMNs may be benign based on final pathology results.

• One-third of mixed-IPMNs had no main pancreatic duct involvement, challenging existing risk stratification.