Feasibility of Central Lymphadenectomy During Low Ligation of Inferior Mesenteric Artery in Laparoscopic Colorectal Cancer Surgery

INTRODUCTION: The optimal level of inferior mesenteric artery (IMA) ligation during colorectal cancer (CRC) surgery remains controversial. Low ligation with preservation of the left colic artery (LCA) may maintain bowel perfusion, but concerns persist regarding adequacy of central lymph node dissection. AIM: To evaluate the technical feasibility and short-term safety of central lymphadenectomy at the IMA root during low ligation with preservation of the LCA in laparoscopic CRC surgery. METHODS: This prospective observational study included 30 patients with nonmetastatic sigmoid colon or rectal adenocarcinoma who underwent laparoscopic resection between October 2025 and April 2026 at the National Cancer Institute, Cairo University. Low ligation of the IMA with LCA preservation and central lymphadenectomy at the IMA root was performed in all cases. Feasibility, lymph node retrieval, operative outcomes, and short-term postoperative outcomes were assessed. RESULTS: All procedures were completed laparoscopically without conversion to open surgery. Preservation of the LCA and successful central lymphadenectomy were achieved in all patients. Mean total lymph node harvest was 24 ± 4, while mean central node retrieval was 5 ± 1. R0 resection was achieved in all cases. Mean operative time was 180 ± 19 minutes. Postoperative complications occurred in 10% of patients, including one case of anastomotic leakage (3.3%). Median hospital stay was 4 days. CONCLUSIONS: Central lymphadenectomy during low ligation of the IMA is feasible and safe in laparoscopic CRC surgery, providing adequate nodal harvest while preserving colonic vascular supply.