Level of vascular ligation and association with oncological expediency in sigmoid and rectal cancer

INTRODUCTION: The techniques and oncology feasibility of high vascular ligation of the inferior mesenteric artery along with their varieties – low tie (LT) and high tie (HT) techniques in left-sided colon and rectal cancer, were described more than 100 years ago by Miles and Moynihan. However, the relationship between the level of vascular ligation and the microperfusion of the proximal anastomosis segment, on the one hand, and the volume and quality of lymphatic dissection, on the other, are the subject of numerous clinical trials and discussions. The vegetative nerve spare in the different approaches is also included in a consideration. Despite the well-established modern standardization in conventional and laparoscopic left colon and rectal cancer surgery, some surgeons still do ligation at the a. rectalis superior level in rectal cancer, which contradicts modern oncology principles.