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Review
. 2024 Apr 11;22(1):92.
doi: 10.1186/s12957-024-03374-w.

Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis

Roberto Cirocchi  1 , Matteo Matteucci  2 , Justus Randolph  3 , Francesca Duro  4 , Luca Properzi  4 , Stefano Avenia  4 , Bruno Amato  5 , Ruggiero Iandoli  6 , Giovanni Tebala  7 , Carlo Boselli  4 , Piero Covarelli  4 , Paolo Sapienza  8
Affiliations
Review

Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis

Roberto Cirocchi et al. World J Surg Oncol. .

Abstract

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: 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: 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, I2 = 44.3% (95% CI 8.9%-65.9%), Q = 39.48, p = .012. When disaggregated by evaluation type, the difference in PPEs between evaluation types was negligible. For cadaveric dissection, the PPE was 99.7% (95% CI 99.1%-100.0%) compared to 99.0% (95% CI 98.1%-99.7%).

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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow diagram of studies included
Fig. 2
Fig. 2
Assessment of quality and risk of bias by the AQUA tool
Fig. 3
Fig. 3
Prevalence of ICBN for continent
Fig. 4
Fig. 4
Prevalence estimates for the ICBN
Fig. 5
Fig. 5
Doi plot
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Fig. 6
Funnel plot
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Fig. 7
Random effects by Evaluation type
Fig. 8
Fig. 8
Random effects by Region
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Fig. 9
Patients with ICBN section
Fig. 10
Fig. 10
Patients with ICBN preservation
See this image and copyright information in PMC

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