Surveillance for intraductal papillary mucinous neoplasms (IPMNs) reveals a tenfold increased risk of pancreatic adenocarcinoma compared to the general population.

• Cumulative incidence of malignancy at 60 months is 0.97%.
• The highest risk is associated with main pancreatic duct dilation ≥5 mm (SIR: 26.5) and BMI ≥30 (SIR: 20.6).

Surgeons should consider personalizing surveillance strategies based on individual risk factors to enhance early detection in high-risk patients and minimize unnecessary imaging in low-risk cases.