Hwasun Jeonnam National University Hospital Clarifies Clinical Effects of Inferior Mesenteric Artery Ligation Height

Published in the International Journal "JAMA Surgery"

Surgeons treating cancer patients in essential local healthcare settings have joined forces to produce world-class clinical evidence.

On July 2, Hwasun Jeonnam National University Hospital announced that a study clarifying the clinical effects of the ligation height of the inferior mesenteric artery (IMA)—a topic of longstanding debate in rectal cancer surgery—was published in JAMA Surgery, the most prestigious international journal in the field of surgery, thereby earning international recognition for its excellence.

Professor Changhyun Kim, Department of Colorectal Surgery, Hwasun Jeonnam National University Hospital. Provided by Hwasun Jeonnam National University Hospital.

This study was a multicenter randomized clinical trial carried out by the K-CROSS (Honam, Chungcheong, and Yeongnam Colorectal Surgery Society) collaborative research team, with cooperation from seven university hospitals across the Honam, Chungcheong, and Yeongnam regions. Professor Junseok Park of Chilgok Kyungpook National University Hospital and Professor Kibum Bae of Inje University Busan Paik Hospital served as co-corresponding authors, while Professor Changhyun Kim of the Department of Colorectal Surgery at Hwasun Jeonnam National University Hospital participated as the first author.

K-CROSS is a clinical research network established by colorectal surgeons from the Honam, Chungcheong, and Yeongnam regions. Medical professionals in essential local healthcare continue to produce high-level clinical evidence through collaborative research based on their experience accumulated from cancer surgeries, emergency care, outpatient and inpatient care, and resident education.

The study aimed to determine which surgical technique—high ligation of the inferior mesenteric artery or low ligation that preserves the left colic artery—was safer for patients and more helpful for functional recovery in rectal cancer surgery.

The research team conducted minimally invasive anterior resection, using either laparoscopy or robotic surgery, for 314 patients with stage I to III rectal cancer at seven domestic university hospitals from 2019 to 2024, and then randomly assigned and compared the two surgical methods.

The results showed that the occurrence rate of anastomotic leakage, the most significant postoperative complication, was 4.9% in the low ligation group and 6.0% in the high ligation group, with no statistically significant difference. There were also no differences between the two groups in terms of bowel, urinary, or sexual function, and quality of life assessed over 12 months after surgery.

This study provided clinical evidence that, when a skilled surgeon performs standardized minimally invasive surgery, a tailored surgical strategy that takes into account the patient's vascular anatomy, tumor location, bowel length and tension, and the surgeon's experience is more important than the ligation height itself.

Furthermore, the study demonstrated that both high and low ligation can be performed safely and effectively, providing important evidence for the standardization of rectal cancer surgery.

Notably, it is significant that university hospitals in the Honam, Chungcheong, and Yeongnam regions—rather than large hospitals in the Seoul metropolitan area—registered patients and conducted long-term follow-up according to the same research protocol, thereby establishing high-quality clinical evidence worthy of publication in a world-leading journal.

This is regarded as a representative case that demonstrates the potential for essential local healthcare settings to conduct clinical research capable of influencing global treatment guidelines.

Professor Changhyun Kim said, "This study is especially meaningful because it was a multicenter randomized clinical trial carried out through close collaboration among local university hospital medical staff participating in the K-CROSS research group. We will continue to develop clinical experience accumulated in essential local healthcare settings into evidence-based research to raise the standard of patient care and contribute to the advancement of international treatment guidelines."

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