{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:53:14Z","timestamp":1793127194960,"version":"4.5.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"\n Importance<\/jats:title>\n The optimal level of inferior mesenteric artery (IMA) ligation during rectal cancer resection remains controversial because of potential trade-offs between anastomotic integrity and functional outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether low ligation of the IMA reduces the rate of anastomotic leakage compared with high ligation in patients undergoing minimally invasive anterior resection for rectal cancer.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter, prospective, randomized clinical trial enrolled patients with clinical stage I through III rectal cancer between July 2019 and August 2024. Patients scheduled for laparoscopic or robotic anterior resection were randomized to undergo either high or low ligation of the IMA.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n High ligation (ligation at the root of the IMA) or low ligation (ligation distal to the origin of the left colic artery).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary end point was the rate of anastomotic leakage. Secondary end points included surgical complications and functional outcomes (bowel, urinary, and sexual function) assessed at 12 months postoperatively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 314 randomized patients, 293 were included in the modified intention-to-treat analysis (143 who received low ligation and 150 high ligation). The median (IQR) age was 64.0 (55.3-73.0) years; there were 102 female patients (34.8%) and 191 male patients (65.2%). Symptomatic anastomotic leakage occurred in 7 of 143 patients (4.9%) in the low-ligation group and 9 of 150 (6.0%) in the high-ligation group (risk ratio, 0.82; 95% CI, 0.31-2.13;\n P<\/jats:italic>\n \u2009=\u2009.68). Overall 30-day postoperative morbidity was 14.0% (20\/143 patients) vs 22.0% (33\/150 patients) (\n P<\/jats:italic>\n \u2009=\u2009.08). At 12 months, bowel function (mean [SD] Low Anterior Resection Syndrome [LARS] score, 15.8 [12.8] in the low-ligation group vs 17.3 [11.8] in the high-ligation group;\n P<\/jats:italic>\n \u2009=\u2009.32) and the proportion of patients with major LARS (24\/121 [19.8%] in the low-ligation group vs 25\/130 in the high-ligation group [19.2%];\n P<\/jats:italic>\n \u2009&amp;gt;\u2009.99) were similar between groups; other functional and quality-of-life outcomes were also comparable.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, low ligation of the IMA did not significantly reduce the rate of anastomotic leakage compared with high ligation. Both techniques appear to be safe and feasible for minimally invasive rectal cancer surgery, with comparable complication rates and long-term functional outcomes.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n Clinical Research Information Service identifier: KCT0003523<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.2248","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:32:26Z","timestamp":1782315146000},"page":"776","source":"Crossref","is-referenced-by-count":3,"title":["Inferior Mesenteric Artery Ligation Level and Anastomotic Leakage in Low Anterior Resection"],"prefix":"10.1001","volume":"161","author":[{"given":"Chang Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Yeun","family":"Park","sequence":"additional","affiliation":[{"name":"Colorectal Cancer Centre, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyung Mo","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Colorectal Cancer Centre, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gi Won","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Surgery, Research Institute of Clinical Medicine of Jeonbuk National University\u2013Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-Ha","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Chungnam National University Hospital & College of Medicine, Chungnam National University, Daejeon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duck-Woo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Seok","family":"Park","sequence":"additional","affiliation":[{"name":"Colorectal Cancer Centre, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki Beom","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Surgery, Paik Institute for Clinical Research, Inje University, College of Medicine, Inje University, Busan Paik Hospital, Busan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heong Rok","family":"Kim","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyu Seok","family":"Kim","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moo Jun","family":"Baek","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Ro","family":"Lee","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taek-ku","family":"Lee","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Kyu","family":"Baek","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Uk","family":"Bae","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nak Song","family":"Sung","sequence":"additional","affiliation":[{"name":"for the Korean ColoRectal surgeOn Study Group of the Southern Province (K-CROSS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung 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