Next-generation sequencing significantly alters surgical decision-making for branch-duct intraductal papillary mucinous neoplasms, providing clarity when traditional guidelines fall short.

• Surgical plans shifted to surveillance in 43% of distal pancreatectomy and 61% of pancreatoduodenectomy scenarios when NGS was negative.
• Conversely, with positive NGS results, surveillance plans shifted to surgery 90% and 72% of the time, respectively.

This tool enhances decision confidence and reduces variability among clinicians, guiding better patient selection for surgery.

• Confidence in management decisions rose significantly (OR 4.66), and inter-physician agreement improved (κ from 0.044 to 0.590 post-NGS).