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049; mural nodules ≥ 10mm vs  10mm 77% vs 95%, log-rank test p = 0.003). The estimated 5-year DSS of conservatively managed IPMN patients with mural nodules and main duct dilation was 91%. Only IPMN patients with plural HRS or large nodule formation might have an increased mortality risk. This is an important insight that can help facilitate appropriate clinical decision-making, especially in the elderly or high-surgical risk IPMN patients. The estimated 5-year DSS of conservatively managed IPMN patients with mural nodules and main d