One of the frequent complications for patients undergo mastectomy is post-mastectomy pain syndrome (PMPS). The postulated cause of PMPS is an injury of the intercostobrachial nerve (ICBN) during mastectomy, and/or radiation therapy. As the ICBN has a close connection with axillary lymph nodes, the risk of injury to this nerve is high during lymph nodes dissection. Studies comparing ICBN preservation and dissection for the management of PMPS are diverse and scarce. Therefore, this meta-analysis aimed to compare the efficacy of preservation of the ICBN versus its dissection for patients who underwent breast surgery.
We conducted computer literature search of Web of Science, PubMed, Cochrane CENTRAL, and Scopus from inception until October 2022. Relevant outcomes were pooled as an odds ratio (OR) using RevMan version 5.4 for Windows. The PROSPERO registration number for this study is CRD42022320452.
Data from 11 studies (980 patients) meeting our eligibility criteria. Six RCTs and five observational studies, were included in the final analysis. Our analysis favored preservation of the ICBN over its dissection in terms of anesthesia and hypoesthesia [OR 0.50, (95% CI, 0.31 to 0.82); P = 0.006] and [OR 0.33, (95% CI, 0.16 to 0.68); P = 0.003], respectively. Whereas, the overall effect favored ICBN dissection over preservation in the case of hyperesthesia [OR 4.34, (95% CI, 1.43 to 13.15); P = 0.01]. Conversely, no significant variance was detected between the two groups in terms of pain, paresthesia, analgesia, numbness, and diminished sensation.
Ultimately, this meta-analysis reveals that preservation of the ICBN through axillary lymph node dissection, when compared to its dissection, appeared to decrease the risk of some sensory disturbance parameters as anesthesia and hypoesthesia. Future analysis on a broader scale population is needed to more strongly assess the efficacy of ICBN preservation on a wider range of parameters.
The authors.
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All authors have declared no conflicts of interest.