Level of Vascular Ligation for Sigmoid Colon Cancer: Does It Matter? The Pina Low‐T Study

Background and methods: In sigmoid colon cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin (high ligation, HLG) or distal to the left colic artery bifurcation (low ligation, LLG). While high ligation facilitates lymph node harvest and mobilization, it may compromise colonic perfusion and increase nerve injury risk. Low ligation preserves the LCA and may improve anastomotic blood supply. We conducted a retrospective multicenter study including patients who underwent sigmoidectomy for sigmoid colon cancer between January 2017 and December 2022. Short- and long-term outcomes were compared between HLG and LLG. Results: A total of 185 patients were included (127 HLG, 58 LLG). Median postoperative length of stay was similar (6 vs. 5 days; p = 0.879). Anastomotic leak rates were 5.5% in HLG and 1.7% in LLG (p = 0.438). Patients undergoing LLG had a higher comorbidity burden, and more than half of the cohort was aged ≥ 70 years. Lymph node yield was higher in HLG (20 vs. 15; p < 0.001). Three-year disease-free survival (85.5% vs. 87.3%; p = 0.751) and overall survival (89.7% vs. 80.7%; p = 0.098) were comparable, with no differences in recurrence patterns. Conclusions: IMA ligation level does not significantly influence outcomes. However, in elderly or fragile patients, low ligation achieves very low leak rates without compromising oncological safety.