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Better Results with a Gentler Approach in Rectal and Sigmoid Cancer Surgery

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Low Versus High Ligation of Inferior Mesenteric Artery in Rectal and Sigmoid Cancers A Systematic Review, Meta-analysis, and Trial Sequential Analysis DOI 10.1245s10434-025-

Doctors often remove a blood vessel called the inferior mesenteric artery (IMA) during surgery for rectal or sigmoid cancer. There are two ways to do this: high ligation (closer to the start of the artery) or low ligation (closer to where the artery splits). Doctors have debated which way is better.

A new review looked at 15 studies with over 2,500 patients. It found that low ligation led to better survival five years after surgery. Patients who had low ligation were also less likely to have a serious problem called an anastomotic leak. This is when the reconnected bowel leaks after surgery, which can be dangerous.

Importantly, low ligation did not make the cancer treatment less effective. It also didn’t make the surgery longer or riskier in other ways. Patients still had enough lymph nodes removed to check the spread of the cancer.

This study shows that low ligation can be a safer and more effective option for people having surgery for rectal or sigmoid cancer. It helps patients live longer and lowers the risk of dangerous leaks after surgery, without affecting cancer control.

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