title: Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery.
abstract: BACKGROUND
  Defaecatory function is often poor after anterior resection. Denervation of the neorectum following high ligation of the inferior mesenteric artery (IMA) is a possible cause of impaired defaecatory function. The purpose of this randomized clinical trial was to clarify whether the level of ligation of the IMA in patients with rectal cancer affects defaecatory function.
  
  
  METHODS
  Between 2008 and 2011, patients who underwent anterior resection for rectal cancer were randomized to receive either high or low ligation of the IMA. The primary endpoint was to demonstrate the superiority of low ligation in terms of defaecatory function.
  
  
  RESULTS
  One hundred patients were enrolled in the study; 51 were randomized to high ligation of the IMA and 49 to low ligation. There were no differences between the groups in terms of clinical data, except tumour stage, which was more advanced in the high-ligation group (P = 0·046). Nor were there any differences in defaecatory function, self-assessment of defaecation, Faecal Incontinence Quality of Life scale or continence score between groups at 3 months and 1 year. The number of harvested lymph nodes was similar. The rate of symptomatic anastomotic leakage was 16 per cent in the high-ligation group and 10 per cent in the low-ligation group (P = 0·415).
  
  
  CONCLUSIONS
  The level of ligation of the IMA in patients with rectal cancer did not affect defaecatory function or the incidence of postoperative complications.
  
  
  BACKGROUND
  NCT00701012 (http://www.clinicaltrials.gov).
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1, Kimiidera, Wakayama 641-8510, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Matsuda
authors.forename: T
authors.initials: T
authors.lastname: Hotta
authors.forename: K
authors.initials: K
authors.lastname: Takifuji
authors.forename: S
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Y
authors.initials: Y
authors.lastname: Oku
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.forename: Y
authors.initials: Y
authors.lastname: Mitani
authors.forename: J
authors.initials: J
authors.lastname: Ieda
authors.forename: Y
authors.initials: Y
authors.lastname: Mizumoto
authors.forename: H
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003672:Defecation / Q000502:physiology*; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012004:Rectal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*