我们的研究目的是确定外科医生在处理胰管内乳头状黏液性肿瘤（IPMN）上的差异是否受到风险感知的差异所驱动，并量化医生在改变他们的推荐建议时的风险门槛。外科医生在IPMN的处理方式上存在广泛差异。我们对美洲肝胆胰学会（AHPBA）成员进行了调查，为参与者提供了两个详细的临床情景，并要求他们在手术切除和监测之间进行选择。我们也要求他们判断IPMN患者患癌的可能性以及手术治疗可能导致什么严重并发症。最后，我们要求外科医生评估癌症风险水平，以确定他们何时会改变治疗建议。共有150名外科医生参加了该研究。医生们在手术建议上存在差异（第一篇情景19％，第二篇12％），并且他们对癌症风险和手术并发症的感知也存在差异（第一篇和第二篇的分位距分别为2-10％，10-20％，20-30％）。在调整外科医生特征后，癌症风险感知高于中位数的外科医生比低于中位数的外科医生建议手术的可能性高22个百分点（27％对5％）（95％CI 11,34％; P <0.001）。外科医生更改他们的推荐建议的中位风险门槛为15％（第一篇和第二篇）。建议手术的医生比建议监测的医生更容易改变他们的推荐建议（第一篇：10.0比15.0，P = 0.06;第二篇：7.0比15.0，P = 0.05）。患者接受的IPMN治疗在很大程度上取决于医生感知病变癌症风险的方式。改善IPMN癌症风险预测的努力可能会导致治疗差异的减少。 版权所有©2023 Wolters Kluwer Health，Inc. 保留所有权利。

We aimed to determine whether surgeon variation in management of IPMN is driven by differences in risk perception and quantify surgeons' risk threshold for changing their recommendations.Surgeons vary widely in management of intraductal papillary mucinous neoplasms (IPMN).We conducted a survey of members of the Americas HepatoPancreatoBiliary Association (AHPBA), presented participants with 2 detailed clinical vignettes and asked them to choose between surgical resection and surveillance. We also asked them to judge the likelihood that the IPMN harbors cancer and that the patient would have a serious complication if surgery was performed. Finally, we asked surgeons to rate the level of cancer risk at which they would change their treatment recommendation. We examined the association between surgeons' treatment recommendations and their risk perception and risk threshold.150 surgeons participated in the study. Surgeons varied in their recommendations for surgery (19% for vignette 1 (V1) and 12% for V2) and in their perception of the cancer risk (interquartile range [IQR] 2-10% for V1 and V2) and risk of surgical complications (V1 IQR 10-20%, V2 20-30%). After adjusting for surgeon characteristics, surgeons who were above the median in cancer risk perception were 22 percentage points (27% vs. 5%) more likely to recommend resection than those who were below the median (95% CI 11,34%; P<0.001). The median risk threshold at which surgeons would change their recommendation was 15% (V1 and V2). Surgeons who recommended surgery had a lower risk threshold for changing their recommendation than those who recommended surveillance (V1: 10.0 vs. 15.0, P=0.06; V2: 7.0 vs. 15.0, P=0.05).The treatment that patients receive for IPMNs depends greatly on how their surgeons perceive the risk of cancer in the lesion. Efforts to improve cancer risk prediction for IPMNs may lead to decreased variations in care.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.