"THINK BEFORE YOU CUT- PRESERVE TO PERFORM"- A RANDOMIZED TRIAL ON INTERCOSTOBRACHIAL NERVE PRESERVATION AND RECOVERY OF SHOULDER FUNCTION AFTER AXILLARY DISSECTION IN CARCINOMA BREAST PATIENT drprashantkumarprusty@gmail.com

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"THINK BEFORE YOU CUT- PRESERVE TO PERFORM"- A RANDOMIZED TRIAL ON INTERCOSTOBRACHIAL NERVE PRESERVATION AND RECOVERY OF SHOULDER FUNCTION AFTER AXILLARY DISSECTION IN CARCINOMA BREAST PATIENT

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India

Oral or Poster

The intercostobrachial nerve (ICBN), a purely sensory branch from the second intercostal nerve(T2), is frequently transected during axillary dissection in breast cancer surgery, risking sensory disturbance and impaired shoulder mobility. This prospective randomized controlled trial was conducted at tertiary care centre in North India to determine the functional impact of ICBN preservation on postoperative shoulder range of motion (ROM).

Total 140 patients were randomized into two groups: ICBN preservation (n= 70) and ICBN transection (n=70). Study period included from August 2024 till August 2025. ROM and sensory function were assessed preoperatively and postoperatively at 1-, 3-, and 6-months using goniometry and DN4 neuropathic pain questionnaire.

This is an interim analysis of an ongoing research. Preliminary results shows that in the preservation group, ROM improvement was observed in 22.5% at 1 month, 28.4% at 3 months, and 43.5% at 6 months (total 65%). Compared to the ICBN transected groups (mean improvement: 16.7%), results were significantly better at 1 and 6 months (p < 0.03). Subgroup analysis revealed stepped improvement rates: 74.2% (both branches preserved), 62.5% (single branch), and 30.4% (lower branch only), with a perfect positive correlation (Spearman’s ρ = 1.0, p < 0.001) between extent of nerve preservation and functional recovery.

ICBN preservation significantly enhances postoperative shoulder ROM, with maximal benefit when both upper and lower branches are spared. These findings advocate for routine nerve-sparing dissection during axillary clearance to optimize functional outcomes in breast cancer patients.