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BACKGROUND. Long term follow-up of the pancreatic remnant after resection for intraductal papillary mucinous neoplasm (IPMN) is required to determine an understanding of this disease’s recurrence. Seven studies have followed 486 resected IPMN cases with a mean follow-up time of 26 to 53 months showing a 2% recurrence of disease. OBJECTIVE. To examine a large single institution resection database for IPMN maintained for annual life-long follow-up.METHODS. Using a prospective IRB-approved database we reviewed 203 pancreatic resections for IPMN between 1989 and 2010. Annual pancreas protocol CT was the method of imaging. RESULTS. Of the 203 resected specimens the IPMN lesions were - adenoma (38%), borderline (25%), carcinoma in situ (CIS,16%), and invasive cancer (21%). Surgical margins were benign in all but one case with CIS (0.5%). At median follow-up of 40 months, 8% (17/203) patients were found to have new disease at a median interval of 38 months [range 4-127 mo] from initial resection. All of these had negative surgical margins for dysplasia except one with adenoma. No treatment was required for 12 cases with side-branch disease by imaging while surgical treatment was required in 5 (2%) - 2 adenomas, 1 carcinoma in situ, and 2 invasive ductal carcinoma (one with liver mets). There was no relationship between the 17 cases with new lesions and the 186 without lesions in demographics, procedure type, duct location, histology, or original margin status. CONCLUSIONSPossibly because of life-long annual imaging we found a higher incidence of recurrence than the literature’s 2%. Following partial pancreatic resection for IPMN and a 40 month follow-up with annual imaging we found 8% of cases developed a new IPMN lesion in the pancreatic remnant and 2% required a second resection. We suspect, as our follow-up time increases, that new lesions will constantly appear regardless if a negative surgical margins at initial resection.