BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) are precursors of pancreatic ductal adenocarcinoma and often harbor KRAS and GNAS mutations. Although disease progression may take a decade or longer, very late recurrence after curative resection is rare. The treatment options for older patients remain limited due to their poor tolerance to standard chemotherapy. CASE SUMMARY Herein, we report the case of a 92-year-old woman with multicentric main duct microinvasive intraductal papilla