Low ligation of the inferior mesenteric artery improves outcomes for rectal and sigmoid cancer patients.

• Low ligation significantly boosts 5-year overall survival (HR 0.69, p = 0.026).
• It reduces anastomotic leak rates (OR 0.71, p = 0.050) without affecting disease-free survival or lymph node yield.
• No increase in overall complications, operative time, or blood loss was observed.

This supports low ligation as the preferred technique in rectosigmoid cancer surgery for better patient outcomes.