High versus low IMA ligation: lymph node yield and anastomosis feasibility impact

This study investigated the postoperative complications and pathological outcomes of patients undergoing high and low ligation of the inferior mesenteric artery. After ligation of the inferior mesenteric artery, indocyanine green (ICG) angiography staining technology was used to determine the blood supply location and complete anastomosis instead of traditional empirical judgment. We analyzed 380 patients with rectal or sigmoid colon cancer. The results showed no significant differences in gender, age, body mass index, diabetes, other comorbidities, ASA classification, estimated intraoperative blood loss, preoperative albumin levels, tumor pathological type, and postoperative hospital stay. However, the high ligation group had higher preoperative CEA levels, a lower proportion of hypertension, longer surgical duration, later T and N stages, higher hospitalization costs, and a higher proportion of ostomy creation. There was no difference in the incidence of deep space infection and fistulas between the two groups, and the overall complication rate was also similar. More lymph nodes were obtained in the high ligation group. In summary, ICG angiography can effectively ensure the blood supply to the anastomotic site, reduce the possibility of anastomotic fistula caused by insufficient blood supply to the anastomotic site, and high ligation is associated with more lymph node dissection. These findings highlight the objective assessment capabilities of ICG in determining blood supply to the anastomotic intestinal tract and the advantages of high ligation in terms of thorough lymph node dissection.