Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis.
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
11 Apr 2024
11 Apr 2024
Historique:
received:
16
11
2023
accepted:
28
03
2024
medline:
12
4
2024
pubmed:
12
4
2024
entrez:
11
4
2024
Statut:
epublish
Résumé
The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and sentinel lymph node biopsy in breast cancer and melanoma patients. The aim of this systematic review and meta-analysis was to investigate the different origins and branching patterns of the intercostobrachial nerve also providing an analysis of the prevalence, through the analysis of the literature available up to September 2023. The protocol for this study was registered on PROSPERO (ID: CRD42023447932), an international prospective database for reviews. The PRISMA guideline was respected throughout the meta-analysis. A systematic literature search was performed using PubMed, Scopus and Web of Science. A search was performed in grey literature through google. We included a total of 23 articles (1,883 patients). The prevalence of the ICBN in the axillae was 98.94%. No significant differences in prevalence were observed during the analysis of geographic subgroups or by study type (cadaveric dissections and in intraoperative dissections). Only five studies of the 23 studies reported prevalence of less than 100%. Overall, the PPE was 99.2% with 95% Cis of 98.5% and 99.7%. As expected from the near constant variance estimates, the heterogeneity was low, I The prevalence of ICBN variants was very high. The dissection of the ICBN during axillary lymph-node harvesting, increases the risk of sensory disturbance. The preservation of the ICBN does not modify the oncological radicality in axillary dissection for patients with cutaneous metastatic melanoma or breast cancer. Therefore, we recommend to operate on these patients in high volume center to reduce post-procedural pain and paresthesia associated with a lack of ICBN variants recognition.
Sections du résumé
BACKGROUND
BACKGROUND
The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and sentinel lymph node biopsy in breast cancer and melanoma patients. The aim of this systematic review and meta-analysis was to investigate the different origins and branching patterns of the intercostobrachial nerve also providing an analysis of the prevalence, through the analysis of the literature available up to September 2023.
MATERIALS AND METHODS
METHODS
The protocol for this study was registered on PROSPERO (ID: CRD42023447932), an international prospective database for reviews. The PRISMA guideline was respected throughout the meta-analysis. A systematic literature search was performed using PubMed, Scopus and Web of Science. A search was performed in grey literature through google.
RESULTS
RESULTS
We included a total of 23 articles (1,883 patients). The prevalence of the ICBN in the axillae was 98.94%. No significant differences in prevalence were observed during the analysis of geographic subgroups or by study type (cadaveric dissections and in intraoperative dissections). Only five studies of the 23 studies reported prevalence of less than 100%. Overall, the PPE was 99.2% with 95% Cis of 98.5% and 99.7%. As expected from the near constant variance estimates, the heterogeneity was low, I
CONCLUSIONS
CONCLUSIONS
The prevalence of ICBN variants was very high. The dissection of the ICBN during axillary lymph-node harvesting, increases the risk of sensory disturbance. The preservation of the ICBN does not modify the oncological radicality in axillary dissection for patients with cutaneous metastatic melanoma or breast cancer. Therefore, we recommend to operate on these patients in high volume center to reduce post-procedural pain and paresthesia associated with a lack of ICBN variants recognition.
Identifiants
pubmed: 38605346
doi: 10.1186/s12957-024-03374-w
pii: 10.1186/s12957-024-03374-w
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
92Informations de copyright
© 2024. The Author(s).
Références
Mewa Kinoo S, Singh B. Complex regional pain syndrome of the breast and chest wall. Breast J. 2016;22(3):366–8.
doi: 10.1111/tbj.12585
pubmed: 26945823
Soares EW. Anatomical variations of the axilla. Springerplus. 2014;3:306.
doi: 10.1186/2193-1801-3-306
pubmed: 25045608
pmcid: 4093907
Kumar P, Meena RN, Sheikh BH, Belliappa V, Pais AV, et al. Intercostobrachial nerve - anatomical considerations and its importance in carcinoma breast of female patients. Ann Surg Perioper Care. 2016;1(2):1013.
Zhu JJ, Liu XF, Zhang PL, Yang JZ, Wang J, Qin Y, Zhang GL, et al. Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer. Genet Mol Res. 2014;13(4):9315–23.
doi: 10.4238/2014.January.24.13
pubmed: 24615083
DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics, 2013. CA Cancer J Clin. 2014;64(1):52–62.
doi: 10.3322/caac.21203
pubmed: 24114568
Kubala O, Prokop J, Jelínek P, Ostruszka P, Tošenovský J, Ihnát P, et al. Anatomicko-chirurgická studie průběhu interkostobrachiálních nervů (ICBN) v axile při exenteraci I. a II. etáže axily u karcinomu prsu a maligního melanomu [Anatomic-surgical study of intercostobrachial nerve (ICBN) course in axilla during I. and II. Level of axilla clearance in breast cancer and malignant melanoma]. Rozhl Chir. 2013;92(6):320–9. Czech.
pubmed: 23965317
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
doi: 10.1136/bmj.n71
pubmed: 33782057
pmcid: 8005924
Henry BM, Tomaszewski KA, Ramakrishnan PK, et al. Development of the Anatomical Quality Assessment (AQUA) Tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat. 2017;30:6–13.
doi: 10.1002/ca.22799
pubmed: 27718281
Özşahin MK, Kaynak G, Afacan MY, et al. Anatomical variations of intercostobrachial nerve: a potential candidate for neurotization after traumatic median nerve injury? Ulus Travma Acil Cerrahi Derg. 2023;29:22–9.
pmcid: 10198354
Melhem J, Amarin M, Odeh G, Al-Bustami N, Al-Lauzy H, Ayoub R. Intercostobrachial nerve (ICBN) preservation versus sacrifice in axillary dissection: randomized controlled trial. Am J Clin Oncol. 2021;44(5):206–9.
doi: 10.1097/COC.0000000000000809
pubmed: 33710131
Kaur N, Kumar R, Jain A, et al. Sensory changes and postmastectomy pain following preservation of intercostobrachial nerve in breast cancer surgery: a prospective randomized study. Indian J Surg Oncol. 2021;12(1):108–13.
doi: 10.1007/s13193-020-01193-5
pubmed: 33814840
Chirappapha P, Kongdan Y, Vassanasiri W, Ratchaworapong K, Sukarayothin T, Supsamutchai C, et al. Evaluation the effect of preserving intercostobrachial nerve in axillary dissection for breast cancer patient. Gland Surg. 2019;8(6):599–608.
doi: 10.21037/gs.2019.10.06
pubmed: 32042666
pmcid: 6989897
Soubhagya Ranjan Nayak, Smita Singh Banerjee. Anatomic variations of the extrathoracic course of the intercostobrachial nerve and its clinical significance. Gland Surg. 2019;8(6):599–608.
Orsolya HB, Coros MF, Stolnicu S, Georgescu R, et al. Does the surgical management of the intercostobrachial nerve influence the Postoperatory Paresthesia of the upper limb and life quality in breast cancer patients? Chirurgia (Bucur). 2017;112(4):436–42.
doi: 10.21614/chirurgia.112.4.436
pubmed: 28862120
Foroni L, Siqueira MG, Martins RS, Oliveira GP. The intercostobrachial nerve as a sensory donor for hand reinnervation in brachial plexus reconstruction is a feasible technique and may be useful for restoring sensation. Arq Neuropsiquiatr. 2017;75(7):439–45.
doi: 10.1590/0004-282x20170073
pubmed: 28746430
Kailash D, Balkund S, Priyadharshini. A study on variations of intercostobrachial nerve. MedPulse – Int J Anat 2017;4(2):14–6.
doi: 10.26611/1001423
Darwish A, Mlees A, El-Gendy M, Elghazeery M. Preservation of lateral thoracic vein and intercostobrachial nerve in breast conservative surgery. Ain Shams J Surg. 2015;8(1):53–60.
doi: 10.21608/asjs.2015.195073
Taira N, Shimozuma K, Ohsumi S, et al. Impact of preservation of the intercostobrachial nerve during axillary dissection on sensory change and health-related quality of life 2 years after breast cancer surgery. Breast Cancer. 2014;21(2):183–90.
doi: 10.1007/s12282-012-0374-x
pubmed: 22932759
Andersen KG, Aasvang EK, Kroman N, Kehlet H. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand. 2014;58(10):1240–8.
doi: 10.1111/aas.12393
pubmed: 25307709
Khan A, Chakravorty A, Gui GP. In vivo study of the surgical anatomy of the axilla. Br J Surg. 2012;99(6):871–7.
doi: 10.1002/bjs.8737
pubmed: 22505319
Verma S, Kala R, Bhargava G, Yadav R, Singh R, Maurya P, et al. Evaluation of the role of preservation of the intercostobrachial nerve on the post-mastectomy pain syndrome in breast cancer patients of North India. Internet J Surg 23. 2009;23:2.
Ferreira BP, Soares. Morbidade cirúrgica pós-biópsia de linfonodo sentinela e esvaziamento axilar: estudo comparativo em mulheres com e sem preservação do nervo intercostobraquial. Rev Assoc Med Bras. 2008;54(6):517–21.
Loukas M, Hullett J, Louis RG Jr, Holdman S, Holdman D. The gross anatomy of the extrathoracic course of the intercostobrachial nerve. Clin Anat. 2006;19(2):106–11.
doi: 10.1002/ca.20226
pubmed: 16470542
Torresan RZ, Cabello C, Conde DM, Brenelli HB. Impact of the preservation of the intercostobrachial nerve in axillary lymphadenectomy due to breast cancer. Breast J. 2003;9(5):389–92.
doi: 10.1046/j.1524-4741.2003.09505.x
pubmed: 12968959
Freeman SR, Washington SJ, Pritchard T, Barr L, Baildam AD, Bundred NJ. Long term results of a randomised prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol. 2003;29(3):213–5.
doi: 10.1053/ejso.2002.1409
pubmed: 12657228
Cunnick GH, Upponi S, Wishart GC. Anatomical variants of the intercostobrachial nerve encountered during axillary dissection. Breast. 2001;10(2):160–2.
doi: 10.1054/brst.2000.0226
pubmed: 14965578
O’Rourke MG, Tang TS, Allison SI, Wood W. The anatomy of the extrathoracic intercostobrachial nerve. Aust N Z J Surg. 1999;69(12):860–4.
doi: 10.1046/j.1440-1622.1999.01718.x
pubmed: 10613285
Nayak SR, Banerjee SS. Anatomic variations of the extrathoracic course of the intercostobrachial nerve and its clinical significance. Asian J Med Sci. 2018;9(5):77–80.
doi: 10.3126/ajms.v9i5.20291
Henry BM, Graves MJ, Pękala JR, Sanna B, Hsieh WC, Tubbs RS, et al. Origin, branching, and communications of the intercostobrachial nerve: a meta-analysis with implications for Mastectomy and axillary lymph node dissection in breast cancer. Cureus. 2017;9(3):e1101.
pubmed: 28428928
pmcid: 5393909
Warrier S, Hwang S, Koh CE, Shepherd H, Mak C, Carmalt H, et al. Preservation or division of the intercostobrachial nerve in axillary dissection for breast cancer: meta-analysis of randomised controlled trials. Breast. 2014;23(4):310–6.
doi: 10.1016/j.breast.2014.01.014
pubmed: 24582033
Abdullah TI, Iddon J, Barr L, Baildam AD, Bundred NJ. Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer. Br J Surg. 1998;85(10):1443–5.
doi: 10.1046/j.1365-2168.1998.00843.x
pubmed: 9782034
Salmon RJ, Ansquer Y, Asselain B. Preservation versus section of intercostal-brachial nerve (IBN) in axillary dissection for breast cancer–a prospective randomized trial. Eur J Surg Oncol. 1998;24(3):158–61.
doi: 10.1016/S0748-7983(98)92793-7
pubmed: 9630850
Feigl GC, Litz RJ, Marhofer P. Anatomy of the brachial plexus and its implications for daily clinical practice: regional anesthesia is applied anatomy. Reg Anesth Pain Med. 2020;45(8):620–7.
doi: 10.1136/rapm-2020-101435
pubmed: 32471922
Charalambous MP, Charalambous CP. Incidence of chronic groin pain following open mesh inguinal hernia repair, and effect of elective division of the ilioinguinal nerve: meta-analysis of randomized controlled trials. Hernia. 2018;22(3):401–9.
doi: 10.1007/s10029-018-1753-9
pubmed: 29550948
Cirocchi R, Sutera M, Fedeli P, Anania G, Covarelli P, Suadoni F, Boselli C, Carlini L, Trastulli S, D’Andrea V, Bruzzone P. Ilioinguinal nerve neurectomy is better than preservation in Lichtenstein Hernia repair: a systematic literature review and meta-analysis. World J Surg. 2021;45(6):1750–60.
doi: 10.1007/s00268-021-05968-x
pubmed: 33606079
pmcid: 8093155