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

• Published in: Annals of medicine and surgery Vol. 86; no. 2; pp. 1003 - 1011
• Main Authors: Al-Dardery, Nada M, Khaity, Abdulrhman M, Albakri, Khaled A, Abdelsattar, Ahmed T, Benmelouka, Amira Y, Lee, Theodore, Foppiani, Jose A, Lin, Samuel J
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins 01-02-2024
• Subjects: Reviews; preservation; breast cancer; post-mastectomy pain syndrome; intercostobrachial nerve; dissection
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1097/MS9.0000000000001622

This meta-analysis aimed to compare the efficacy of preservation of the intercostobrachial nerve (ICBN) versus its dissection for patients who underwent breast surgery.
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.
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);
= 0.006] and [OR 0.33, (95% CI, 0.16-0.68);
= 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);
= 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)
= 0.38], paraesthesia [OR 0.88, (95% CI, 0.49-1.60);
= 0.68], and analgesia [OR 1.46, (95% CI, 0.05-45.69);
= 0.83].
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.