Original Research Article
Year: 2017 | Month: April | Volume: 7 | Issue: 4 | Pages: 61-67
Preservation of Intercostobrachial Nerve during Mastectomy in Patients of Breast Cancer
Dr. Neha Mishra1, Dr. Nityasha2, Dr. Pooja Sharma1, Dr. Anubhav1
Postgraduate Student1, Professor2
Department of General Surgery, Pt. B.D. Sharma PGIMS, Rohtak-124001, Haryana (India)
Corresponding Author: Dr. Neha Mishra
Background: Breast cancer is the leading type of cancer in women, accounting for 25% of all cases. One in every eight women developed breast cancer of which approximately 60 percent are to be treated surgically for primary breast tumour resection and axillary lymph node staging. Since more and more patient are surviving breast cancer as a result of progress in diagnosis and treatment, the population at risk for chronic pain and other late complications can therefore be expected to increase in coming years.
Aims and Objectives: Role of preservation of intercostobrachial nerve in the postoperative morbidity of patients of modified radical mastectomy, incidence of successful preservation of intercostobrachial nerve and factors responsible for division of the intercostobrachial nerve in modified radical mastectomy for breast cancer.
Materials and Methods: A total of 30 patients with a histological diagnosis of breast cancer and an indication for modified radical mastectomy were included. The 19 patients in whom the attempt was successful were treated as Case group while the Control group consisted of 11 patients in whom the attempt to preserve the nerve remained unsuccessful.
Results: In our study, 6 (20%) patients had a clinical staging of T1N0, only 1 (3.3%) had T1N1, 10 (33.3%) had stage T2N0 while 13 (43.3%) patients had T2N1 stage breast cancer (p >0.05). An average of 13.03±5.28 lymph nodes were harvested per patient, the mean in control group (13.18±5.01) being slightly higher than case group (12.95±5.56) though the difference was statistically non-significant (p>0.05). The sensory symptoms decreased with time in both the groups. On 42nd day follow up, 16 (53.3%) patients were symptomatic, 8 (72.7%) from the control group and 8 (42.1%) from case group, the difference was statistically significant (0.034) implying decreased sensory symptoms at the end of 6 weeks on preservation of intercostobrachial nerve. Pain was the commonest (50%) sensory symptom observed followed by numbness (40%), for the entire study population on 42nd day assessment. Neuropathic pain was seen in 30% of all the patients (p <0.05). Anaesthesia was the commonest (33.3%) sensitivity alternation observed followed by hypoesthesia (23.3%).
Conclusion: Preservation of intercostobrachial nerve during modified radical mastectomy leads to a statistically significant decrease in the postoperative sensory symptoms including numbness and neuropathic pain, as well as sensory deficits including anaesthesia and hypoaesthesia, thereby, reducing the postoperative morbidity of the patients without compromising the axillary clearance (in stages upto T2N1) or increasing the incidence of postoperative complications.
Key words: Intercostobrachial, Mastectomy, Breast Cancer .