EP197 - Safety Of Stoma Reversal In Patients With Known Metastatic Cancer

Purpose/Background: Presence of a stoma is a highly morbid condition that can have a significant impact on patient quality of life and requires investment of time and financial resources for proper care. Despite the associated morbidity, stoma reversal is often delayed in patients with metastatic disease due to concern for increased risk of post-operative complications, though data on outcomes is lacking. We sought to determine the rate of post-operative complications for patients with metastatic cancer undergoing ostomy reversal.

Methods/Interventions: Patients who underwent ostomy reversal at our institution from 2017-2023 were identified from billing records. A retrospective chart review was performed, focusing on patients with known metastatic cancer at the time of their ostomy reversal. Information on the rate and severity of post-operative complications within 30 days of reversal was collected from both the inpatient and outpatient electronic medical records. Complication severity was classified using the Clavien-Dindo system. 30-day readmission and mortality rates were also recorded.

Results/Outcomes: Fifty-seven patients were identified with known metastatic disease, 15 (26.3%) were M+ and 42 (73.7%) were N+. Of these 57 patients, 12 (21.1%) underwent ongoing cancer-directed treatment after their ostomy reversal. 13/57 (22.8%) patients suffered from a complication during their post-operative admission. Of these complications, 4 were Clavien-Dindo grade 1 (SBO, ileus, or superficial SSI opened at bedside), 7 were grade 2 (bleeding requiring transfusion, Clostridium difficile infection, atrial fibrillation, or diarrhea requiring pharmacologic intervention), and 2 were grade 3 (return to operating room). There were no grade 4 or 5 complications. Of the patients with complications, 8 had undergone loop ileostomy reversal, 3 had end ileostomy reversal, 1 had loop colostomy reversal, and 1 had end colostomy reversal.

Three additional complications were identified at the initial post-operative clinic visit, all of which were Clavien-Dindo grade 2 (UTI, thrush, diarrhea requiring pharmacologic intervention) and all of which were in patients who underwent loop ileostomy reversal. 15.8% of patients (9/57) were readmitted within 30 days of surgery (6 loop ileostomy reversals and 3 end ileostomy reversals). Reasons for readmission included SBO, intra-abdominal abscess, need for local wound care, UTI, dehydration, and anastomotic leak. 4/57 patients (7.0%) required surgical (2) or IR (2) intervention within the 30-day post-operative period. There were no 30-day mortalities in this cohort of patients.

Conclusion/Discussion: The rate of major complications (grades 3-5) following ostomy reversal in this cohort of patients with known metastatic cancer was low (7.0%) and comparable to the rate for allcomers undergoing ostomy reversal. This suggests that presence of metastatic disease alone should not preclude ostomy reversal for patients who are otherwise good candidates for surgery. The morbidity of the stoma should be weighed against the morbidity of reversal to guide care discussion.