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Review
. 2023 Dec 13;86(2):1003-1011.
doi: 10.1097/MS9.0000000000001622. eCollection 2024 Feb.

Preservation versus dissection of the intercostobrachial nerve for breast cancer surgeries: a systematic review and meta-analysis

Nada M Al-Dardery  1 , Abdulrhman M Khaity  2 , Khaled A Albakri  3 , Ahmed T Abdelsattar  1 , Amira Y Benmelouka  4 , Theodore Lee  5 , Jose A Foppiani  6   7 , Samuel J Lin  7
Affiliations
Review

Preservation versus dissection of the intercostobrachial nerve for breast cancer surgeries: a systematic review and meta-analysis

Nada M Al-Dardery et al. Ann Med Surg (Lond). .

Abstract

Introduction: This meta-analysis aimed to compare the efficacy of preservation of the intercostobrachial nerve (ICBN) versus its dissection for patients who underwent breast surgery.

Methods: The authors searched Web of Science, PubMed, Cochrane CENTRAL, and Scopus from inception until March 2023. Records were screened for eligible studies, and all relevant outcomes were pooled as an odds ratio (OR) with the corresponding 95% CI in the meta-analysis models using RevMan version 5.4.

Results: These results from 11 studies (1021 patients) favored preservation of the ICBN over its dissection in terms of anaesthesia and hypaesthesia [OR 0.50, (95% CI, 0.31-0.82); P = 0.006] and [OR 0.33, (95% CI, 0.16-0.68); P = 0.003], respectively. Whereas the overall effect favored ICBN dissection over preservation in the case of hyperaesthesia [OR 4.34, (95% CI, 1.43-13.15); P = 0.01]. Conversely, no significant variance was detected between the two groups in terms of pain [OR 0.68, (95% CI, 0.28-1.61) P = 0.38], paraesthesia [OR 0.88, (95% CI, 0.49-1.60); P = 0.68], and analgesia [OR 1.46, (95% CI, 0.05-45.69); P = 0.83].

Conclusion: This meta-analysis revealed that the preservation of the ICBN has a significant effect on the disturbance of sensory parameters of hypaesthesia and anaesthesia when compared to its dissection. Further studies with larger sample sizes are recommended to precisely compare both techniques on a wider range of parameters.

Keywords: breast cancer; dissection; intercostobrachial nerve; post-mastectomy pain syndrome; preservation.

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Conflict of interest statement

Not applicable.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
PRISMA flow diagram of studies’ screening and selection.
Figure 2
Figure 2
Forest plots of odds ratio in pain. (A) Overall pain; (B) overall pain after sensitivity analysis; (C) subgroup analysis. ICBN, intercostobrachial nerve.
Figure 3
Figure 3
Forest plots of odds ratio. (A) Anaesthesia; (B) hypaesthesia; (C) hypaesthesia after sensitivity analysis. ICBN, intercostobrachial nerve.
Figure 4
Figure 4
Forest plots of odds ratio. (A) Hyperaesthesia; (B) paraesthesia; (C) analgesia. ICBN, intercostobrachial nerve.
Figure 5
Figure 5
Forest plots of odds ratio. (A) Numbness; (B) numbness after sensitivity analysis. ICBN, intercostobrachial nerve.
Figure 6
Figure 6
Forest plots of odds ratio in diminished sensation. ICBN, intercostobrachial nerve.
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