Morbidity related to intercostobrachial nerve damage following axillary surgery for breast cancer

Surgical staging of the axilla is carried out either by axillary clearance or an axillary sampling procedure. During both axillary sampling and axillary clearance the intercostobrachial nerve can be damaged. A questionnaire was sent to 150 patients, 50 of whom had an axillary clearance preserving the intercostobrachial nerve, 50 who had axillary clearance dividing the nerve and 50 who had axillary sampling. One hundred and nineteen of the 150 surveys were returned and 110 were fully completed and analysed. Patients having axillary node sampling had significantly less numbness than patients having an axillary node clearance (P = 0.0003). Patients who had the intercostobrachial nerve preserved during axillary clearance had significantly less numbness than those who had their nerve divided (P = 0.041). There was also a much lower frequency of numbness in the distribution of the intercostobrachial nerve, 10% versus 35%, P = 0.03. Even when patients who had an axillary clearance and had their nerve preserved were compared with patients having an axillary node sampling there was less numbness in the sampling group, P = 0.038. There was no difference in pain in patients undergoing axillary clearance whether they had the nerve preserved or divided, but of those who did develop pain it was much more likely to be moderate or severe in the nerve divided group, P < 0.0001. There was a significant increase in the number of women reporting arm stiffness in the axillary clearance group when the intercostobrachial nerve was divided, P = 0.008. This study demonstrates that axillary sampling produces less numbness than an axillary clearance whether the intercostobrachial nerve is preserved or not. In patients undergoing a full axillary clearance, preservation of the intercostobrachial nerve limits the morbidity of this procedure.