Preservation versus section of intercostal-brachial nerve (IBN) in axillary dissection for breast cancer - a prospective randomized trial

Aims. Preservation of the intercostal-brachial nerve is advocated to reduce side-effects of axillary dissection for breast cancer. We conducted a prospective randomized trial to compare functional results: sensory deficit and/or shoulder pain in preserved (group I) vs sacrificed (group II) intercostal-brachial nerve (IBN). Methods. From July 1993 to April 1994, 128 patients presenting with an invasive operable breast cancer were operated on by mastectomy n = 28 or lumpectomy n = 100 and axillary dissection. The patients were eligible for randomization when the IBN was preserved at the end of the axillary dissection. Group I (nerve preservation) included 66 patients and group II (nerve section) 62 patients. Results. The two groups were well balanced for TNM, type of surgery, number of nodes dissected and positive, post-operative adjuvant treatment. Examinations were conducted at 3, 6 and 12 months after surgery. Sensory deficit in the IBN area was reported by one patient in group I and four patients in group II at 3 months (P=0.36, NS). No patients, apart from one in group II, reported functional trouble at 18 months. Major shoulder motion, limitation and pain developed in four patients in group I and three in group II (NS). This was attributed to depression and treated adequately. Analysis of sensory deficit was impossible in these patients. Conclusions. Conservation of the IBN, while anatomically preferable, is not functionally necessary during axillary dissection for breast cancer.