Evidence map›Paper›PMID 41139188›Full record

SynthesisAnnals of surgical oncology2026

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.

Richard Sassun, Annaclara Sileo, Jyi Cheng Ng, Giulio Mari, Francesco Brucchi, Davide Ferrari, Roberto Cirocchi, Nicholas P McKenna, David W Larson

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. 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 · 2026
    Review
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Richard SassunDivision of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA. richardsassun@hotmail.it.ORCID http://orcid.org/0000-0001-7649-4703
Annaclara SileoDivision of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Jyi Cheng NgDivision of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Giulio MariGeneral Surgery Unit, Division of General Surgery, Pio XI Hospital, Desio, MB, Italy.
Francesco BrucchiGeneral Surgery Residency Program, University of Milan, Milan, Italy.
Davide FerrariDivision of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Roberto CirocchiDepartment of General Surgery, Ospedale di Terni, Università di Perugia, Terni, Italy.
Nicholas P McKennaDivision of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
David W LarsonDivision of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe optimal level of the inferior mesenteric artery (IMA) ligation in rectosigmoid cancer surgery remains controversial, with ongoing debate about the balance between oncologic adequacy and anastomotic integrity. This meta-analysis compared high ligation (HL) versus low ligation (LL) of IMA in terms of postoperative and long-term oncologic outcomes using randomized controlled trials (RCTs). MATERIALS AND

methodsA systematic search of 5 databases (inception-May 2025) identified 15 RCTs comparing LL and HL in rectal or sigmoid cancer. Primary outcomes included 5-year overall survival (OS), disease-free survival (DFS), overall complications, and anastomotic leak (AL) rates. Secondary outcomes included lymph node yield, operative time, and blood loss. Trial sequential analysis (TSA), risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were performed.

resultsA total of 2576 patients were included. LL significantly improved 5-year OS (HR 0.69; 95% CI 0.50-0.96; p = 0.026) and reduced AL rates (OR 0.71; 95% CI 0.51-1.00; p = 0.050), without compromising DFS or lymph node yield. TSA confirmed the OS benefit and robustness of AL reduction, with the cumulative Z-curve crossing both the conventional and trial sequential monitoring boundaries for benefit. LL was not associated with increased overall complications, operative time, or blood loss. GRADE ratings indicated moderate-to-high certainty for key outcomes.

conclusionsLow ligation of the IMA offers a survival advantage and reduced anastomotic leak risk without compromising oncologic safety. These findings support LL as the preferred approach in rectosigmoid cancer surgery, though further RCTs are warranted to strengthen the evidence for certain outcomes.

Indexed as

Mesenteric Artery, InferiorRectal NeoplasmsSigmoid NeoplasmsAnastomotic LeakHumansLigationPostoperative ComplicationsPrognosisRandomized Controlled Trials as TopicSurvival RateAnastomotic leakInferior mesenteric arteryLigationRectal cancerSigmoid cancerSurvival

Identifiers

PMID41139188

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.