High versus low ligation of the inferior mesenteric artery during transanal total mesorectal excision for low rectal cancer: impact on postoperative anastomotic leakage.

INTRODUCTION

Whether preserving the left colic artery (LCA) during transanal total mesorectal excision is beneficial remains unclear. This study evaluated the effects of LCA-preserving low ligation versus high ligation of the inferior mesenteric artery without LCA preservation on anastomotic leakage.

METHODS

We retrospectively reviewed patients with low rectal cancer at the First Affiliated Hospital of Chongqing Medical University (January 2014-January 2024). After propensity score matching, 182 patients were assigned to LCA preservation (n = 91, low ligation) or non-preservation (n = 91, high ligation) groups according to whether the LCA was preserved. Perioperative characteristics, pathological findings, and incidence of anastomotic leakage were compared, and subgroup analyses were performed.

RESULTS

The incidence of postoperative leakage in the LCA preservation group was lower than in the non-preservation group (4.3% vs. 13.2%, p = 0.036). Among patients who received neoadjuvant therapy, LCA preservation was associated with a lower incidence of anastomotic leakage rates (7.0% vs. 24.0%, p = 0.049).

DISCUSSION: LCA preservation may have clinical value in selected patients with low rectal cancer, particularly those receiving neoadjuvant therapy.