Effects of Mesenteric Artery Ligation Level on Patients with Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Multi-Center Cohort Study

Abstract

Background and purpose For patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (nCRT), there is currently limited research on the optimal level of inferior mesenteric artery (IMA) ligation during surgery. We carried out a retrospective cohort study to analyze the impact of IMA ligation level on surgical outcomes and long-term patient prognosis. Methods The data originated from a multicenter randomized controlled trial conducted across six tertiary referral hospitals in Beijing, involving LARC patients undergoing nCRT followed by radical surgery. Patients were divided into high (HL) and low ligation (LL) groups based on the ligation level of IMA. Evaluation parameters included surgical outcomes, complications, long-term survival, and quality of life questionnaires. Results From August 2017 to April 2022, a total of 337 patients were included in the analysis. The number of lymph nodes retrieved was higher in the LL group compared to the HL group. There were no significant differences between the two groups in terms of operation time, intraoperative blood loss, and other factors. Conclusion For LARC patients undergoing nCRT, the level of IMA ligation during radical surgery does not significantly impact complications or long-term prognosis. The selection of ligation pattern should be based on a comprehensive assessment of factors including metastatic risk, vascular anatomy, comorbidity (such as atherosclerosis), and surgical skills of the surgeons.