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Background: Pancreatic intraductal papillary mucinous neoplasm (IPMN) is a precursor to invasive pancreatic adenocarcinoma. IPMN follows a relatively indolent course from adenoma to carcinoma and is often amenable to surgery. Numerous studies have explored preoperative parameters that predict malignant or invasive disease and the need for resection. The risk of recurrence in patients with invasive or metastatic disease is known to be high. However, there is little data on the frequency and timing of recurrence and the need for post-operative surveillance in patients with non-invasive disease. OBJECTIVE: We aimed to investigate the patterns of recurrent IPMN among patients with non-invasive disease. METHODS: We performed a retrospective chart review of 91 patients who underwent pancreatic resection for non-invasive (benign or carcinoma-in-situ) IPMN between 1997 and 2009. Patients undergoing total pancreatectomy or those with invasive carcinoma were excluded, as were patients lost to follow-up before 6 weeks had elapsed since their surgery. Data collected included: type of resection, histology, margin status, postoperative follow-up time, additional pancreatic resections and histology of any recurrent disease. RESULTS: Mean follow-up time for all 68 patients included in the analysis was 25 months (median=14 months, range=1.5 -128 months.) Three patients (4%) had recurrent disease requiring a second surgery. Two of these patients had carcinoma-in-situ in the primary resection specimen, while one patient had positive margins. Mean time to the second surgery was 20 months (median=18 months, range= 14-27 months.) An additional seven patients who have not undergone a second resection had lesions suspicious for recurrent IPMN observed by endoscopy. Two patients in the endoscopy group had positive margins; none had malignant disease in the primary resection. Mean time until the first endoscopic observation of potentially recurrent disease was 32 months, (median=15 months, range= 3-128 months.) One additional patient who underwent R0 resection for high grade IPMN re-presented 19 months later with inoperable pancreatic adenocarcinoma. Mean follow-up for all recurrent disease (both surgical and endoscopic follow-up) was 28 months. CONCLUSIONS: Recurrent IPMN remains a concern, even after resection of non-invasive disease. However, the majority of recurrences present within a few years of the primary resection. Surveillance protocols for patients who have undergone IPMN resection would likely provide the greatest benefit within this time period.