SynthesisLangenbeck's archives of surgery2023
Inferior mesenteric artery ligation level in rectal cancer surgery: still no answer-a systematic review and meta-analysis.
Synthesis in Langenbeck's archives of surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 5 syntheses or guidelines pooled it, 13 citations in OpenAlex.
- Pooled it
- Low Versus High Ligation of Inferior Mesenteric Artery in Rectal and Sigmoid Cancers: A Systematic Review, Meta-analysis, and Trial Sequential Analysis of Randomized Controlled Trials.Annals of surgical oncology · 2026Pooled it
- Pooled it
- Pooled it
- [Evidence for the extent and oncological benefits of lymphadenectomy in colon and rectal cancer : A narrative review based on meta-analyses].Chirurgie (Heidelberg, Germany) · 2025Pooled it
- Effects of mesenteric artery ligation level on patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy: a retrospective cohort study.Techniques in coloproctology · 2024Trial
- Does the level of inferior mesenteric artery ligation affect outcomes in rectal cancer: a meta-analysis.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Review
- Faster bowel recovery with superior haemorrhoidal artery preservation in patients undergoing sigmoidectomy for diverticular disease: A retrospective cohort study from the diverticular disease registry trial.Journal of minimal access surgery · 2026Article
- Development and validation of machine learning models for predicting no. 253 lymph node metastasis in left-sided colorectal cancer using clinical and CT-based radiomic features.Cancer imaging : the official publication of the International Cancer Imaging Society · 2025Article
- Comparison of short-term surgical outcomes between high and low tie ligation of the inferior mesenteric artery in robotic rectal cancer surgery: a propensity score matching analysis.Journal of robotic surgery · 2025Article
- Article
- Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review.Cancers · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 6 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe aim of this systematic review and meta-analysis is to summarize the current scientific evidence regarding the impact of the level of inferior mesenteric artery (IMA) ligation on post-operative and oncological outcomes in rectal cancer surgery.
methodsWe conducted a systematic review of the literature up to 06 September 2022. Included were RCTs that compared patients who underwent high (HL) vs. anterior (LL) IMA ligation for resection of rectal cancer. The literature search was performed on Medline/PubMed, Scopus, and the Web of Science without any language restrictions. The primary endpoint was overall anastomotic leakage (AL). Secondary endpoints were oncological outcomes, intraoperative complications, urogenital functional outcomes, and length of hospital stay.
resultsEleven RCTs (1331 patients) were included. The overall rate of AL was lower in the LL group, but the difference was not statistically significant (RR 1.43, 95% CI 0.95 to 2.96). The overall number of harvested lymph nodes was higher in the LL group, but the difference was not statistically significant (MD 0.93, 95% CI - 2.21 to 0.34). The number of lymph nodes harvested was assessed in 256 patients, and all had a laparoscopic procedure. The number of lymph nodes was higher when LL was associated with lymphadenectomy of the vascular root than when IMA was ligated at its origin, but there the difference was not statistically significant (MD - 0.37, 95% CI - 1.00 to 0.26). Overall survival at 5 years was slightly better in the LL group, but the difference was not statistically significant (RR 0.98, 95% CI 0.93 to 1.05). Disease-free survival at 5 years was higher in the LL group, but the difference was not statistically significant (RR 0.97, 95% CI 0.89 to 1.04).
conclusionsThere is no evidence to support HL or LL according to results in terms of AL or oncologic outcome. Moreover, there is not enough evidence to determine the impact of the level of IMA ligation on functional outcomes. The level of IMA ligation should be chosen case by case based on expected functional and oncological outcomes.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.