BACKGROUND: The prediction of postoperative pancreatic fistula (POPF) is important. This study aimed to investigate the role of postoperative serum lipase level in predicting POPF. METHODS: Data from 234 consecutive patients who underwent pancreaticoduodenectomy (PD) were collected. The predictive values of serum amylase and serum lipase during postoperative days (PODs) 1 to 3 for POPF were compared. Subgroup analyses were performed to determine the prognostic value of different levels and durations of elevated serum lipase. RESULTS: Fifty-six patients developed POPF. The POPF group exhibited increased levels of serum amylase and lipase from PODs 1 to 3 (all P <
0.001). Compared with serum amylase, serum lipase has greater predictive value for POPF. Specifically, serum lipase had the highest area under the receiver operating characteristic curve (AUC) at POD 1 (0.791). Body mass index >
24 kg/m CONCLUSIONS: Postoperative serum lipase outperformed serum amylase in the prediction of POPF, and patients with normal serum lipase level at POD 1 had favorable outcomes. A sustained increase in the serum lipase level offers no additional prognostic value.