Prognostic impact of low versus high inferior mesenteric artery ligation in rectosigmoid cancer: individual patient data meta-analysis of randomized trials
In brief
Low tie of the inferior mesenteric artery adds only about 1-month to 5-year survival
In a pooled analysis of 1,152 patients from five randomized trials, low ligation of the inferior mesenteric artery produced a 1.4-month longer overall survival and a 0.7-month longer disease-free survival at five years compared with high ligation, but the differences were not statistically significant. Complication rates, lymph-node yield, and operative time were similar, indicating no clear advantage to either technique.
- Journal
- BJS open (Q1)
- Published
- 4 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Alberto Aiolfi, Francesco Cammarata, Emanuele Rausa, Gianluca Bonitta, Antonio Biondi, Luigi Bonavina, et al.
- PMID
- 42725584
- DOI
- 10.1093/bjsopen/zrag120
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 13 September 2026): IMA low vs high ligation meta-analysis
- Picked for Breast and Endocrine Surgery (top studies of the week, 13 September 2026): Individual patient data meta‑analysis of IMA ligation
- Picked for Surgery (top studies of the week, 13 September 2026): Individual patient data meta-analysis of RCTs on IMA ligation
- Picked for Gastrointestinal and Colorectal Surgery (top studies of the week, 13 September 2026): Low vs high IMA ligation in rectosigmoid cancer
- Picked for Gastroenterology (top studies of the week, 13 September 2026): Irrelevant to gastroenterology clinical practice
- Picked for Pediatric Surgery (top studies of the week, 13 September 2026): High-quality evidence in a top journal
- Picked for Pathology and Forensic Medicine (top studies of the week, 13 September 2026): Meta‑analysis of inferior mesenteric artery ligation
Abstract
BACKGROUND: The optimal level of inferior mesenteric artery ligation in rectosigmoid cancer surgery remains a matter of debate. This study evaluated the prognostic impact of low ligation (LL) versus high ligation (HL) after rectal or sigmoid cancer resection. METHODS: A reconstructed individual patient data meta-analysis of randomized clinical trials (RCTs) was performed using restricted mean survival time difference (RMSTD) estimation. PubMed, MEDLINE, Scopus, Web of Science, ClinicalTrials.gov, Cochrane Central Library, and Google Scholar were searched. Primary outcomes were 5-year overall (OS) and disease-free survival (DFS). The RMSTD, risk ratio (RR), standardized mean difference (SMD), and 95% confidence interval (c.i.) were used as pooled effect size measures. The certainty of evidence was categorized with the GRADE framework. RESULTS: Overall, 1152 patients from five RCTs were included; 34% underwent LL. Baseline demographics and pathological tumour stage were balanced among the LL and HL groups. At the 60-month follow-up, the OS and DFS estimates for LL versus HL were 1.40 months (95% c.i. -0.18 to 2.98; moderate level of certainty) and 0.71 months (95% c.i. -1.55 to 3.03; moderate level of certainty). Anastomotic leak (RR 0.71), overall complications (RR 0.79), total number of lymph nodes retrieved (SMD 0.01), and operating time (SMD 0.08) were comparable. CONCLUSION: This meta-analysis did not detect a statistically significant difference in 5-year OS and DFS between LL and HL in patients with rectosigmoid cancer.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.