Wysocki Wojciech, Kisielewski Michał, Dowgiałło-Gornowicz Natalia, Krawczyk Wiktor, Wantulok Jakub, Serednicki Wojciech, Wierdak Mateusz, Oleszczuk Ignacy, Grudzińska Ewa, Mrowiec Sławomir, Molasy Bartosz, Śmigielski Jacek, Klimczak Tomasz, Safiejko Kamil, Wysocki Michał, Richter Karolina, Sachanbiński Tomasz, Wojewoda Tomasz, Pisarska-Adamczyk Magdalena
Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Cracow, Poland, Department of Oncological Surgery, 5th Military Clinical Hospital with Polyclinic in Cracow, Poland, National Institute of Oncology, Maria Sklodowska-Curie Memorial, Scientific Editorial Office, Warsaw, Poland.
Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Cracow, Poland, Department of General and Oncological Surgery, 5th Military Clinical Hospital with Polyclinic in Cracow, Poland.
Pol Przegl Chir. 2025 May 29;97(4):7-12. doi: 10.5604/01.3001.0055.1391.
<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.
引言：结肠造口回纳术是肿瘤切除和非肿瘤切除术后常见的外科手术。60%的非肿瘤患者接受了结肠造口回纳术，而因肿瘤原因接受手术的患者中只有40%进行了该手术。术后病程作为结肠造口回纳率较低的一个可能原因，仍然是一个有争议的问题。
目的：比较因肿瘤和非肿瘤指征行结肠造口术患者的结肠造口回纳术后结局。
材料和方法：多中心前瞻性结肠造口清除（LICO）研究于2022年10月至2023年12月在波兰的20个外科科室进行。根据结肠造口指征将患者分为两组：肿瘤组（第1组）和非肿瘤组（第2组）。主要结局指标为住院时间（LOS）、术后并发症和30天再次手术率。
结果：126例患者中（第1组46例，第2组80例），第1组患者年龄较大（中位数67岁对55.5岁，p<0.05），缺血性心脏病患病率较高（32.6%对10%，p = 0.002）。两组的中位住院时间均为7天（p = 0.656）。并发症发生率（第1组34.8%对第2组43.8%，p = 0.32）和再次手术率（6.5%对12.5%，p = 0.289）无显著差异。两组间术中失血量、手术时间和Clavien-Dindo并发症分级相当。
讨论：结果对肿瘤切除术后结肠造口回纳术风险更高这一假设提出了挑战。相似的结局表明围手术期护理和患者选择比结肠造口的潜在指征更为关键。
结论：肿瘤患者和非肿瘤患者的结肠造口回纳术结局，包括住院时间、并发症和再次手术情况相似，这支持了在无活动性疾病的合适肿瘤病例中该手术的安全性。
研究意义：本研究为指导临床决策和完善指南提供了证据，最终改善结肠造口回纳术患者的结局。
