title: Preservation or division of the intercostobrachial nerve in axillary dissection for breast cancer: meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  Management of the ICBN during axillary dissection is controversial and the division of ICBN is often trivialised. The effect of dividing the ICBN, and its association with sensory disturbance, is unclear. A systematic review and meta-analysis was performed to evaluate the effect of preserving the ICBN during axillary dissection.
  
  
  METHODS
  A systematic literature review and meta-analysis is performed according to the PRISMA and Cochrane Collaboration guidelines.
  
  
  RESULTS
  Three RCTs and four non-RCTs were reviewed. A meta-analysis demonstrated that the incidence of sensory disturbance was significantly lower with preservation of ICBN compared to division of the ICBN with Mantel-Haenzel combined odds ratio 0.31 (0.17-0.57, 95% CI). There was relatively low level of heterogeneity (I(2) = 19%, χ(2) = 2.48, df = 2). The sensory disturbance was more likely to be hyposensitivity when compared to hypersensitivity (p < 0.0001). No difference on number of lymph nodes dissected or operating time was noted.
  
  
  CONCLUSIONS
  This meta-analysis demonstrates that division of the ICBN is associated with higher risk of sensory disturbance, and that the nature of this sensory disturbance is more likely to be hyposensitivity, attributable to reduced nerve function.
authors.affiliation: Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; University of Sydney, Camperdown, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Department of Surgery, Prince of Wales Hospital, Randwick, NSW, Australia. Electronic address: drsanjaywarrier@hotmail.com.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Warrier
authors.affiliation: University of New South Wales, Kensington, NSW, Australia; Department of Surgery, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Sang
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: Cherry E
authors.initials: CE
authors.lastname: Koh
authors.affiliation: University of Sydney, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Shepherd
authors.affiliation: Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: Cindy
authors.initials: C
authors.lastname: Mak
authors.affiliation: Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; University of Sydney, Camperdown, NSW, Australia.
authors.forename: Hugh
authors.initials: H
authors.lastname: Carmalt
authors.affiliation: Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; University of Sydney, Camperdown, NSW, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Solomon
mesh_terms: D001365:Axilla / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology; D006987:Hypesthesia / Q000209:etiology; D007367:Intercostal Nerves / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D009437:Neuralgia / Q000209:etiology; D059351:Organ Sparing Treatments / Q000379:methods; D016032:Randomized Controlled Trials as Topic
keywords: Axillary dissection; Complications; Hyposensitivity; Intercostobrachial nerve; Meta-analysis; Pain