DOES INTERCOSTOBRACHIAL NERVE DESERVE MORE ATTENTION DURING AXILLARY SURGERY FOR BREAST CANCER? OUR INSTITUTIONAL EXPERIENCE.

Objectives: The intercostobrachial nerve (ICBN) is frequently encountered and often transected during axillary lymph node dissection (ALND) for breast cancer, which may contribute to postoperative pain and long-term sensory disturbances. This study aimed to compare postoperative pain and sensory outcomes between ICBN preservation and ICBN division during ALND, and to evaluate the feasibility of nerve preservation. Methods: This prospective comparative study included 60 women undergoing ALND for breast cancer at a tertiary care centre, allocated alternately to an ICBN-preservation group (n = 30) and an ICBN-division group (n = 30). Postoperative pain was assessed using the Visual Analogue Scale (VAS), and sensory disturbances of the upper arm and axilla were evaluated using subjective questionnaires and objective testing with a 10-g monofilament. Assessments were performed at 24 hours, 2 weeks and 3 months. Quality of life was evaluated using the EORTC QLQ-C30 questionnaire. Operative duration, lymph-node yield and technical feasibility of nerve preservation were also recorded. Statistical Analysis: Quantitative variables were summarised as mean ± standard deviation. Between-group comparisons were performed using the Mann–Whitney U test for continuous variables and Fisher's exact test for categorical variables. A p-value <0.05 was considered statistically significant. Results: Sixty patients were included (mean age: preservation group 55.3 years; division group 53.6 years). Pain scores were significantly lower in the ICBN-preservation group at all follow-up intervals, with the greatest difference at 3 months (mean VAS 1.6 vs. 4.13; mean difference -2.53, 95% CI -2.97 to -2.09; p < 0.0001). At 3 months, 90% of patients in the preservation group demonstrated normal upper-arm sensation versus 6.7% in the division group (absolute difference 83.3%, 95% CI 61.9–91.5; p < 0.001), and 43.3% versus 0% had normal axillary sensation (absolute difference 43.3%, 95% CI 23.8–60.8; p < 0.001). Mean axillary lymph-node yield showed no statistically significant difference between groups (preserved 15.8 ± 5.4 vs. sacrificed 18.6 ± 7.7; mean difference -2.8 nodes, 95% CI -6.2 to +0.6; Mann–Whitney U, p = 0.18), with both groups exceeding the ≥10-node threshold for oncological adequacy. The confidence interval remains compatible with a clinically relevant difference, and the study can neither confirm nor exclude one. ICBN preservation increased operative time by approximately 10–20 minutes. Postoperative complications were uncommon, with no statistically significant difference between groups, and quality-of-life scores likewise showed no statistically significant difference. These were exploratory secondary outcomes for which the study had limited power, and a clinically meaningful difference in either cannot be excluded. Conclusions: ICBN preservation during ALND was associated with reduced postoperative pain and improved sensory recovery compared with nerve division, with no statistically significant difference in lymph-node yield or in complication rates; as the study was not powered for these secondary outcomes, no claim of equivalence is made for either. Baseline imbalances in perineural and lymphovascular invasion, a sample size determined by the available caseload rather than by a power calculation, and the alternate-allocation design are limitations that should be considered when interpreting these findings.