Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec;8(6):599-608.
doi: 10.21037/gs.2019.10.06.

Evaluation the effect of preserving intercostobrachial nerve in axillary dissection for breast cancer patient

Prakasit Chirappapha  1 , Methas Arunnart  1 , Panuwat Lertsithichai  1 , Chairat Supsamutchai  1 , Thongchai Sukarayothin  1 , Monchai Leesombatpaiboon  1
Affiliations

Evaluation the effect of preserving intercostobrachial nerve in axillary dissection for breast cancer patient

Prakasit Chirappapha et al. Gland Surg. 2019 Dec.

Abstract

Background: The Intercostobrachial nerve (ICBN) is responsible for sensory function in the axillar and upper arm. The majority of surgeons routinely sacrifice the ICBN during axillary lymph node dissection (ALND) because of technical difficulties. Therefore, the aim of this study was to assess the effects of the preservation or division of the ICBN on the incidence of post-operative sensory disturbance, health-related quality of life (HRQOL), and the physical functions of the upper limbs.

Methods: We performed a randomized double-blind trial comparing the incidence of sensory disturbance, HRQOL and physical functions of upper limbs in the preservation and the removal of the ICBN. Clinicians performed sensory evaluation at 2 weeks and 3 months after surgery. The sensory evaluation included questionnaires (subjective evaluation) and physical examination (objective evaluation) to evaluate sensory disturbance of the upper arm. HRQOL and physical function of upper limbs was accessed before surgery and at three months after surgery, using Short Form-36 and QuickDASH questionnaires, both in Thai language versions.

Results: At the end of the surgical procedures there were 15 patients in the preserved group (group P) and 28 patients in the non-preserved group (group N). In as-treated analysis, there was no significant difference between the groups in pain, sensory loss, physical examination of touch and pinprick sensation, and areas of sensory dullness. HRQOL found that the reported pain in P group was higher than N group in both intention-to-treat and as-treated analysis. In the QuickDASH scores of physical functions of the upper limbs there was a significant difference, 9.1 in group P and 20.5 in group N (P=0.013).

Conclusions: ICBN preservation provides no benefit to improving sensation, but there are benefits in HRQOL and physical functions of upper limbs at three months after surgery.

Keywords: Intercostobrachial nerve preservation; axillary lymph node dissection; breast cancer.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The intercostobrachial nerve.
Figure 2
Figure 2
Area of sensory dullness examination. A was the distance from axillary hairline to point that firstly decreased sensation. B was the distance from axillary hair line to olecranon process of ulna.
Figure 3
Figure 3
Trial profile.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Halsted WS. I. The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June, 1889, to January, 1894. Ann Surg 1894;20:497-555. 10.1097/00000658-189407000-00075 - DOI - PMC - PubMed
    1. Fisher B, Wolmark N, Bauer M, et al. The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast. Surg Gynecol Obstet 1981;152:765-72. - PubMed
    1. Graversen HP, Blichert-Toft M, Andersen JA, et al. Breast cancer: risk of axillary recurrence in node-negative patients following partial dissection of the axilla. Eur J Surg Oncol 1988;14:407-12. - PubMed
    1. Kwan W, Jackson J, Weir LM, et al. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 2002;20:4242-8. 10.1200/JCO.2002.09.018 - DOI - PubMed
    1. Assa J. The intercostobrachial nerve in radical mastectomy. J Surg Oncol 1974;6:123-6. 10.1002/jso.2930060206 - DOI - PubMed