Efficacy and Safety of High Versus Low Ligation of the Inferior Mesenteric Artery in Colorectal Cancer Surgery a Systematic Review and Meta-analysis.

INTRODUCTION

To assess the impact of high-tie (HT) versus low-tie (LT) ligation of the inferior mesenteric artery, with or without left colic artery (LCA) preservation, on surgical, oncological, and functional outcomes in colorectal cancer surgery.

METHODS

A systematic review and meta-analysis of 31 randomized controlled trials, cohort, and cadaveric studies (including 10 randomized controlled trials, 11 retrospective cohort studies, 9 prospective cohort studies, and 1 cadaveric study) was conducted. Outcomes included operating time, lymph node yield, conversion to open surgery, anastomotic leakage, urinary dysfunction, recurrence, and survival. Subgroup analyses explored sources of heterogeneity.

RESULTS

Overall, high tie and LT showed no significant differences in apical lymph node yield, anastomotic leakage, urinary dysfunction, recurrence, or metastasis. Operating time and total harvested lymph nodes demonstrated high heterogeneity, with results influenced by surgical techniques and institutional practices. LT showed a nonsignificant trend toward fewer conversions to open surgery. Cadaveric data suggested LCA preservation may reduce feasibility of tension-free anastomosis, while clinical studies indicated lower postoperative complication rates and potential survival benefits with preservation.

CONCLUSIONS

LCA preservation does not consistently affect key outcomes, but subgroup analyses highlight that surgical approach and context play critical roles. Large-scale, standardized trials are warranted to establish definitive recommendations.