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Review
. 2023 Dec 22;16(1):72.
doi: 10.3390/cancers16010072.

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

Antonio Brillantino  1 , Jaroslaw Skokowski  2   3 , Francesco A Ciarleglio  4 , Yogesh Vashist  5 , Maurizio Grillo  1 , Carmine Antropoli  1 , Johnn Henry Herrera Kok  6 , Vinicio Mosca  7 , Raffaele De Luca  8 , Karol Polom  2   9 , Pasquale Talento  10 , Luigi Marano  2   3
Affiliations
Review

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

Antonio Brillantino et al. Cancers (Basel). .

Abstract

Within the intricate field of rectal cancer surgery, the contentious debate over the optimal level of ligation of the inferior mesenteric artery (IMA) persists as an ongoing discussion, influencing surgical approaches and patient outcomes. This narrative review incorporates historical perspectives, technical considerations, and functional as well as oncological outcomes, addressing key questions related to anastomotic leakage risks, genitourinary function, and oncological concerns, providing a more critical understanding of the well-known inconclusive evidence. Beyond the dichotomy of high versus low tie, it navigates the complexities of colorectal cancer surgery with a fresh perspective, posing a transformative question: "Is low tie ligation truly reproducible?" Considering a multidimensional approach that enhances patient outcomes by integrating the surgeon, patient, technique, and technology, instead of a rigid and categorical statement, we argued that a balanced response to this challenging question may require compromise.

Keywords: anastomoticleakage; inferior mesenteric artery ligation; quality of life; rectal cancer surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram showing the process of the literature search.
Figure 2
Figure 2
High-tie ligation: ligation of the inferior mesenteric artery at its origin with left colic artery ligation.
Figure 3
Figure 3
Low-tie ligation: ligation of the superior rectal artery just distal to the left colic artery’s origin.
See this image and copyright information in PMC

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