Colostomy reversal after oncological resections versus non-oncological resections is not associated with worse postoperative outcomes - the results of the Polish Liquidation of Colostomy (LICO) study.

Abstract

<b>Introduction:</b> Colostomy reversal is a common surgical procedure following oncological and non-oncological resections. Colostomy reversal is performed in 60% in of non-oncological patients, and in only 40% of patients operated on for oncological reasons. Postoperative course as a possible reason for a lower colostomy reversal rate remains a controversial issue.<b>Aim:</b> To compare postoperative outcomes of colostomy reversal in patients with oncological versus non-oncological indications for colostomy creation.<b>Materials and methods:</b> The multicenter, prospective Liquidation of Colostomy (LICO) study was conducted in 20 surgical departments in Poland between October 2022 and December 2023. Patients were divided into two groups based on colostomy indication: oncological (Group 1) and non-oncological (Group 2). Primary outcomes were the length of hospital stay (LOS), postoperative complications, and 30-day reoperation rates.<b>Results:</b> Among 126 patients (46 in Group 1, 80 in Group 2), Group 1 patients were older (median 67 <i>vs.</i> 55.5 years, p<0.05) and had a higher prevalence of ischemic heart disease (32.6% <i>vs.</i> 10%, p = 0.002). Median LOS was 7 days for both groups (p = 0.656). Complication rates (34.8% in Group 1 <i>vs.</i> 43.8% in Group 2, p = 0.32) and reoperation rates (6.5% <i>vs.</i> 12.5%, p = 0.289) showed no significant differences. Intraoperative blood loss, operative times, and Clavien-Dindo complication grades were comparable between groups.<b>Discussion:</b> The results challenge the assumption that colostomy reversal after oncological resections carries higher risks. Comparable outcomes suggest perioperative care and patient selection are more critical than the underlying indication for colostomy.<b>Conclusions:</b> Colostomy reversal outcomes, including LOS, complications, and reoperations, were similar between oncological and non-oncological patients, supporting its safety in properly selected oncological cases without active disease.<b>Significance of the study:</b> This study provides evidence to guide clinical decision-making and refine guidelines, ultimately improving outcomes for patients undergoing colostomy reversal.