BackgroundIntraductal oncocytic papillary neoplasms (IOPNs) are now considered a separate entity to intraductal papillary mucinous neoplasis (IPMN). Invasive IOPNs are extremely rare, and their recurrence patterns, response to adjuvant chemotherapy and long-term survival outcomes are unknown. MethodsConsecutive patients undergoing pancreatic resection (2010–2020) for invasive IOPNs or adenocarcinoma arising from IPMN (A-IPMN) from 18 academic pancreatic centers worldwide were included. Outcomes of invasive IOPNs were compared with ductal and colloid A-IPMN. Results415 patients were included: 20 invasive IOPN, 331 ductal A-IPMN and 64 colloid A-IPMN. After a median follow-up of 6-years, 45% and 40% of invasive IOPNs had developed recurrence and died, respectively. There was no significant difference in recurrence or overall survival between invasive IOPN and ductal A-IPMN. Overall survival of invasive IOPNs were inferior to colloid A-IPMNs (median time of survival 24.4 months vs. 86.7, months, p = 0.013), but difference in recurrence only showed borderline significance (median time to recurrence, 22.5 months vs. 78.5 months, p = 0.132). Adjuvant chemotherapy, after accounting for high-risk features did not reduce rates of recurrence in IOPN (p = 0.443), ductal carcinoma (p = 0.192), colloid carcinoma (p = 0.574). ConclusionsInvasive IOPNs should be considered an aggressive cancer with a recurrence rate and prognosis consistent with ductal A-IPMN.