Introduction: Pancreatic intraductal papillary mucinous neoplasms (IPMN) are recognized as pre-malignant lesions, corresponding to less than 3% of all pancreatic exocrine neoplasms. The study objectives were: to evaluate the surgical results of our institution, to identify factors predicting malignancy in IPMN and to assess the validity of recently introduced IPMN guidelines in our population. Methods: A single center, retrospective study in patients submitted to surgical resection for IPMN was conducted, between 1/2008-6/2016, to identify predictive factors for malignancy, and to evaluate the surgical results. Results: Thirty-nine patients were submitted to a surgical resection. The median age was 68 years (61.5% females). Adenocarcinoma and high-grade dysplasia were present, in 7 and 4 patients, respectively. A significant association was identified with the phenotype and the degree of atypia (p = 0.001), and duct origin and degree of atypia (p = 0.026). Malignant transformation was associated with intestinal or pancreatic-biliary subtypes. Discussion and Conclusions: Applying the European guidelines, all adenocarcinoma would have undergone surgical resection, but 1 with high-grade dysplasia would not be resected. If we applied the American guidelines, 1 patient with adenocarcinoma and 3 with high-grade dysplasia wouldn´t be submitted to resection. The decision in patients with these lesions requires multidisciplinary teams and a tailored based approach.