title: High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed.
abstract: Nowadays left colon and rectal cancer treatment has been well standardized in both open and laparoscopy. Nevertheless, the level of the ligation of the inferior mesenteric artery (IMA), at the origin from the aorta (high tie) or below the origin of the left colic artery (low tie), is still debated. The objective of the systematic review is to evaluate the current scientific evidence of high versus low tie of the IMA in colorectal cancer surgery. The outcomes considered were overall 30-days postoperative morbidity, overall 30-days postoperative mortality, anastomotic leakage, 5-years survival rate, and overall recurrence rate. A total of 8.666 patients were included in our analysis, 4.281 forming the group undergoing high tie versus 4.385 patients undergoing low tie. Neither the high tie nor the low tie strategy showed an evidence based success, as no statistically significant differences were identified for all outcomes measured. Future high powered and well designed randomized clinical trials are needed to draw definitive conclusion on this dilemma.
authors: Department of General Surgery, University of Perugia, St. Maria Hospital, Via Tristano di Joannuccio, 05100 Terni, Italy. cirocchiroberto@yahoo.it
authors: Roberto
authors: R
authors: Cirocchi
authors: Stefano
authors: S
authors: Trastulli
authors: Eriberto
authors: E
authors: Farinella
authors: Jacopo
authors: J
authors: Desiderio
authors: Nereo
authors: N
authors: Vettoretto
authors: Amilcare
authors: A
authors: Parisi
authors: Carlo
authors: C
authors: Boselli
authors: Giuseppe
authors: G
authors: Noya
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome