Preservation of the Intercostobrachial Nerve during Axillary Surgery: Anatomical Considerations and Clinical Outcomes

Abstract

Background: Injury to the intercostobrachial nerve during axillary lymph-node dissection may result in numbness, paresthesia and persistent neuropathic pain. Evidence regarding nerve preservation in resource-constrained healthcare systems remains limited.

Objective: This study evaluated the anatomical patterns, feasibility and clinical outcomes of intercostobrachial nerve preservation during axillary surgery.

Methods: This prospective multicenter comparative cohort study included 132 women undergoing level I–II axillary lymph-node dissection at three tertiary-care hospitals in Pakistan. The nerve was preserved whenever technically and oncologically feasible. The primary outcomes were medial upper-arm sensory deficit and neuropathic pain at six months. Secondary outcomes included operative time, lymph-node yield, surgical complications and shoulder function. Multivariable logistic regression was performed to identify factors independently associated with sensory deficit and neuropathic pain.

Results: The nerve was preserved in 91 (68.9%) patients and divided in 41 (31.1%). A single trunk was observed in 52.3%, two branches in 34.1%, and three or more branches in 13.6%. Preservation increased the median operative time by seven minutes without reducing lymph-node yield. At six months, sensory deficit occurred in 15.4% of the preservation group and 46.3% of the division group (p<0.001). Neuropathic pain occurred in 9.9% and 29.3%, respectively (p=0.004). Preservation independently reduced sensory deficit and neuropathic pain. Complication rates were comparable.

Conclusion: Intercostobrachial nerve preservation was feasible and improved postoperative sensory outcomes without compromising axillary clearance.