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The optimal level of vascular ligation of the inferior mesenteric artery (IMA) in colorectal surgery still remains debatable with regard to anatomical, technical, and oncologic perspectives. This study was designed to investigate whether high ligation of IMA increases an anastomotic leak in sigmoid and rectal cancer surgery.A retrospective analysis of patients who underwent elective surgery for sigmoid colon and rectal cancer with T2 or more with aprimary anastomosis between April 2004 and March 2009 was performed. Patient and tumour characteristics, surgical data and the incidence of anastomotic leak were analyzed.Four hundred and nine patients were reviewed. The overall incidence of anastomotic leak was 7.1%. Multivariate analyses revealed that history of hypertension (odds ratio = 3.1), tumour located at upper rectum (odds ratio = 5.3), and high ligation of IMA (odds ratio = 6.8) were the independent risk factors of anastomotic leak. Of 27 patients who developed an anastomotic leak after high ligation of IMA,proximal bowel ischemia of the anastomosis was causally implicated in six patients.High ligation of IMA is independently associated with an anastomotic leak in sigmoid and rectal cancer surgery. This studyprovides a warning in clinical setting where high ligation of IMA is indicated.