Feasibility of intercostobrachial nerve reservation in modified radical mastectomy of breast cancer

doi:10.3877/cma. j. issn.1674-0807.2015.02.003

Abstract

Abstract:

Objective

To investigate the feasibility of intercostobrachial nerve (ICBN) reservation in modified radical mastectomy of breast cancer.

Methods

The clinical data of 429 breast cancer patients who received modified radical mastectomy in the Department of Surgical Oncology, Affiliated Hospital of North China University of Science and Technology from June 2004 to June 2013 were retrospectively analyzed, including 112 patients with ICBN reservation(ICBN-reserved group) and 317 with ICBN resection(ICBN-resected group). The operation time, bleeding volume and number of dissected lymph nodes between two groups were compared by t test. The sensory dysfunction rate at postoperative 1 and 6 months, local recurrence and distant metastasis rate between two groups were compared by χ² test.

Results

The operation time, bleeding volume and number of dissected lymph nodes were similar between two groups [ICBN-reserved group vs ICBN-resected group:(96.7±25.8) min vs (99.4±23.9) min, t=-1.00,P=0.320; (121.3±29.0) ml vs (126.8±30.9) ml, t=-1.65,P=0.099;19.6±7.5 vs 18.9±7.1, t=0.95, P=0.342]. The sensory dysfunction rate in ICBN-reserved group was significantly lower than that in ICBN-resected group at postoperative 1 and 6 months [42.9%(48/112) vs 83.9%(266/317), χ² =71.09,P＜0.001; 18.8% (21/112) vs 63.4% (201/317), χ² =66.10, P ＜0.001]. The patients were followed up for 6-36 months (median 36 months). The local recurrence and distant metastasis rates were also similar between two groups [ICBN-reserved group vs ICBN-resected group:16.1%(18/112) vs 19.2%(61/317),χ²=0.55,P=0.457;11.6%(13/112) vs 15.1%(48/317),χ²=0.85,P=0.357].

Conclusion

It is feasible to reserve intercostobrachial nerve in modified radical mastectomy of breast cancer.

Key words: Breast neoplasms, Modified radical mastectomy, Intercostobrachial nerve

Shiwei Zhang, Weiguo Xu, Suli Shi, Chang Shi, Zhaopeng Tang, Shimin Zhang, Ruifen Si, Honghong Xu, Li Chen, Jinji Zhang. Feasibility of intercostobrachial nerve reservation in modified radical mastectomy of breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2015, 09(02): 85-88.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhrxbzz.cma-cmc.com.cn/EN/10.3877/cma. j. issn.1674-0807.2015.02.003

https://zhrxbzz.cma-cmc.com.cn/EN/Y2015/V09/I02/85

Figures/Tables 4

References 14

[1]	Stewert BW, Kleihues P. World cancer report[M]. Lyon:IARC Press,2003:188-193.
[2]	郑莹,吴春晓,吴凡. 中国女性乳腺癌死亡现况和发展趋势[J]. 中华预防医学杂志,2011,45(2):150-154.
[3]	陈万青,张思维,郑荣寿,等. 中国2009 年恶性肿瘤发病和死亡分析[J]. 中国肿瘤,2013,22(1):2-12.
[4]	Maddox WA, Carpenter JT Jr, Laws HL, et al. A randomized prospective trial of radical ( Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients [J].Ann Surg,1983,198(2):207-212.
[5]	Veronesi U, Banfi A, Del Vecchio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection,and radiotherapy in early breast cancer: long-term results[J].Eur J Cancer Clin Oncol,1986,22(9):1085-1089.
[6]	Park CC, Mitsumori M, Nixon A, et al. Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence[J]. J Clin Oncol,2000,18(8):1668-1675.
[7]	Wong L. Intercostal neuromas:a treatable cause of postoperative breast surgery pain[J]. Ann Plast Surg,2001,46(5):481-484.
[8]	Dobrogowski J, Przeklasa-Muszynska A, Wordliczek J.Persistent post-operative pain[J]. Folia Med Cracov, 2008,49(1/2):27-37.
[9]	王雷, 彭泉, 赵成功. 乳腺癌改良根治术保留肋间臂神经[J/CD]. 中华乳腺病杂志:电子版,2012,6(3):292-297.
[10]	Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual[M]. 7th ed. New York: Springer,2010:347-376.
[11]	Abdullah TI, Iddon J, Barr L, et al. Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer[J].Br J Surg,1998,85(10):1443-1445.
[12]	Vecht CJ,Van de Brand HJ,Wajer OJ. Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve[J]. Pain,1989,38(2):171-176.
[13]	Torresan RZ, Cabello C, Conde DM, et al. Impact of the preservation of the intercostobrachial nerve in axillary lymphadenectomy due to breast cancer[J]. Breast J, 2003,9(5):389-392.
[14]	Taylor KO. Morbidity associated with axillary surgery for breast cancer[J]. ANZ J Surg,2004,74(5):314-317.

组别	例数	年龄(岁)	生活地区[例(%)]		肿瘤位置[例(%)]
组别	例数	年龄(岁)	农村	城市	左	右
ICBN保留组	112	51.8±12.3	64(57.1)	48(42.9)	60(53.6)	52(46.4)
ICBN切除组	317	52.2±11.1	165(52.0)	152(47.9)	178(56.2)	139(43.8)
检验值		t=-0.30	χ²=0.86		χ²=0.22
P值		0.767	0.353		0.637
组别	例数	临床分期[例(%)]				病理分期[例(%)]
组别	例数	Ⅰ	Ⅱ_A	Ⅱ_B	Ⅲ_A	pN₀	pN₁	pN₂	pN₃
ICBN保留组	112	23(20.5)	51(45.5)	28(25.0)	10(8.9)	65(58.0)	21(18.8)	18(16.1)	8(7.1)
ICBN切除组	317	75(23.7)	131(41.3)	69(21.8)	42(13.2)	169(53.3)	78(24.6)	37(11.7)	33(10.4)
检验值		χ²=-0.03				χ²=-0.69
P值		0.980				0.490

组别	例数	年龄(岁)	生活地区[例(%)]		肿瘤位置[例(%)]
组别	例数	年龄(岁)	农村	城市	左	右
ICBN保留组	112	51.8±12.3	64(57.1)	48(42.9)	60(53.6)	52(46.4)
ICBN切除组	317	52.2±11.1	165(52.0)	152(47.9)	178(56.2)	139(43.8)
检验值		t=-0.30	χ²=0.86		χ²=0.22
P值		0.767	0.353		0.637
组别	例数	临床分期[例(%)]				病理分期[例(%)]
组别	例数	Ⅰ	Ⅱ_A	Ⅱ_B	Ⅲ_A	pN₀	pN₁	pN₂	pN₃
ICBN保留组	112	23(20.5)	51(45.5)	28(25.0)	10(8.9)	65(58.0)	21(18.8)	18(16.1)	8(7.1)
ICBN切除组	317	75(23.7)	131(41.3)	69(21.8)	42(13.2)	169(53.3)	78(24.6)	37(11.7)	33(10.4)
检验值		χ²=-0.03				χ²=-0.69
P值		0.980				0.490

组别	例数	术后1个月[例(%)]		术后6个月[例(%)]
组别	例数	有	无	有	无
ICBN保留组	112	48(42.9)	64(57.1)	21(18.8)	91(81.2)
ICBN切除组	317	266(83.9)	51(16.1)	201(63.4)	116(36.6)
χ²值		71.09		66.10
P值		＜0.001		＜0.001

组别	例数	术后1个月[例(%)]		术后6个月[例(%)]
组别	例数	有	无	有	无
ICBN保留组	112	48(42.9)	64(57.1)	21(18.8)	91(81.2)
ICBN切除组	317	266(83.9)	51(16.1)	201(63.4)	116(36.6)
χ²值		71.09		66.10
P值		＜0.001		＜0.001

组别	例数	局部复发[例(%)]		远处转移[例(%)]
组别	例数	有	无	有	无
ICBN保留组	112	18(16.1)	94(83.9)	13(11.6)	99(88.4)
ICBN切除组	317	61(19.2)	256(80.8)	48(15.1)	269(84.8)
χ²值		0.55		0.85
P值		0.457		0.357

Please choose a citation manager

Content to export