The surgical effect of inferior mesenteric artery ligation level in rectal cancer and sigmoid colon cancer: a meta-analysis of randomized controlled trials.

Abstract

Background: In radical surgery for sigmoid and rectal cancer, two main approaches are used to ligate the inferior mesenteric artery (IMA): high ligation at the root of the IMA and low ligation at the distal origin of the left colonic artery (LCA). There has been debate as to which technique is more optimal.

Methods: PubMed, EMBASE, Cochrane Library, Web of Science, and CNKI databases were searched for relevant information from their inception to March 10, 2025. Methodological quality of reviews was assessed by the AMSTAR-2 tool.

Results: Sixteen relevant studies involving a total of 1778 patients were included in the meta-analysis. Compared with high ligation, low-position ligation of the IMA was associated with a significantly lower incidence of anastomotic leakage (RR: 0.44, 95% CI: 0.26-0.72, P < 0.05) and faster postoperative recovery of gastrointestinal function (SMD: -0.21, 95% CI: -0.37 -0.05, P < 0.05). No significant differences were observed in the length of hospitalization, tumor recurrence, lymph node harvest, urinary retention, urinary incontinence, operative bleeding, overall survival at 5 years, disease‑free survival at 5 years and sexual dysfunction were not statistically significant (P > 0.05).

Conclusion: In colorectal cancer surgery, low ligation of the IMA can reduce the incidence of anastomotic leakage and improve postoperative defecation function without increasing intraoperative blood loss, the risk of tumor recurrence, or affecting sexual function. Therefore, low ligation may a better technique than high ligation in this context.