{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T19:40:15Z","timestamp":1777059615575,"version":"3.51.4"},"reference-count":101,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T00:00:00Z","timestamp":1703203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Within the intricate field of rectal cancer surgery, the contentious debate over the optimal level of ligation of the inferior mesenteric artery (IMA) persists as an ongoing discussion, influencing surgical approaches and patient outcomes. This narrative review incorporates historical perspectives, technical considerations, and functional as well as oncological outcomes, addressing key questions related to anastomotic leakage risks, genitourinary function, and oncological concerns, providing a more critical understanding of the well-known inconclusive evidence. Beyond the dichotomy of high versus low tie, it navigates the complexities of colorectal cancer surgery with a fresh perspective, posing a transformative question: \u201cIs low tie ligation truly reproducible?\u201d Considering a multidimensional approach that enhances patient outcomes by integrating the surgeon, patient, technique, and technology, instead of a rigid and categorical statement, we argued that a balanced response to this challenging question may require compromise.<\/jats:p>","DOI":"10.3390\/cancers16010072","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T04:44:40Z","timestamp":1703220280000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Antonio","family":"Brillantino","sequence":"first","affiliation":[{"name":"Department of Surgery, \u201cA. Cardarelli\u201d Hospital, Via A. Cardarelli 9, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaroslaw","family":"Skokowski","sequence":"additional","affiliation":[{"name":"Department of Medicine, Academy of Applied Medical and Social Sciences\u2014AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych\u20142 Lotnicza Street, 82-300 Elbl\u0105g, Poland"},{"name":"Department of General Surgery and Surgical Oncology, \u201cSaint Wojciech\u201d Hospital, \u201cNicolaus Copernicus\u201d Health Center, Jana Paw\u0142a II 50, 80-462 Gda\u0144sk, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1489-1954","authenticated-orcid":false,"given":"Francesco A.","family":"Ciarleglio","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Hepato-Pancreato-Biliary (HPB) Unit\u2014APSS, 38121 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2030-6712","authenticated-orcid":false,"given":"Yogesh","family":"Vashist","sequence":"additional","affiliation":[{"name":"Department Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Grillo","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cA. Cardarelli\u201d Hospital, Via A. Cardarelli 9, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmine","family":"Antropoli","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cA. Cardarelli\u201d Hospital, Via A. Cardarelli 9, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnn Henry","family":"Herrera Kok","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery\u2014Upper GI Unit, University Hospital of Le\u00f3n, 24008 Le\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinicio","family":"Mosca","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences, Universit\u00e0 degli Studi della Campania \u201cLuigi Vanvitelli\u201d, 80138 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9337-0769","authenticated-orcid":false,"given":"Raffaele","family":"De Luca","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, IRCCS Istituto Tumori \u201cGiovanni Paolo II\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karol","family":"Polom","sequence":"additional","affiliation":[{"name":"Department of Medicine, Academy of Applied Medical and Social Sciences\u2014AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych\u20142 Lotnicza Street, 82-300 Elbl\u0105g, Poland"},{"name":"Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasquale","family":"Talento","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-9588","authenticated-orcid":false,"given":"Luigi","family":"Marano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Academy of Applied Medical and Social Sciences\u2014AMiSNS: Akademia Medycznych I Spolecznych Nauk Stosowanych\u20142 Lotnicza Street, 82-300 Elbl\u0105g, Poland"},{"name":"Department of General Surgery and Surgical Oncology, \u201cSaint Wojciech\u201d Hospital, \u201cNicolaus Copernicus\u201d Health Center, Jana Paw\u0142a II 50, 80-462 Gda\u0144sk, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1080\/13645706.2016.1198381","article-title":"Techniques and Technology Evolution of Rectal Cancer Surgery: A History of More than a Hundred Years","volume":"25","author":"Lirici","year":"2016","journal-title":"Minim. 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