Effects of different inferior mesenteric artery ligation levels on the prognosis of patients with low rectal cancer.

Background: Regarding low rectal cancer (RC) low anterior resection (LAR), a specific consensus regarding the optimal level of inferior mesenteric artery (IMA) ligation does not exist.

Objectives: To systematically evaluate the effects of different IMA ligation methods on the prognosis of patients with low RC, so as to further guide clinical treatment.

Material And Methods: Between January 2013 and December 2018, 158 patients with low RC underwent LAR. According to the IMA ligation method used, the cases were divided into the low-ligation group (LL group; n = 66) and the high-ligation group (HL group; n = 92). The basic information, operation indicators, postoperative data, and long-term survival in the 2 groups were compared.

Results: Sixty cases in the HL group and 60 cases in the LL group were successfully matched using propensity score matching (PSM). There were no statistically significant differences in intraoperative bleeding, intraoperative time, postoperative hospital stay, harvested lymph nodes (LNs), postoperative complications (including urinary retention, urinary incontinence, anastomotic leaks, bowel obstruction, incisional infection, and anal function 3 months after surgery), overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis between the 2 groups (p > 0.05). Compared with the HL group, the time to first flatus and the time to fluid intake were shorter in the LL group (p < 0.05).

Conclusions: In general, the different IMA ligation methods have no significantly different effects on the prognosis of patients with low RC, but the LL group showed restored intestinal motility earlier.