The Clinical Significance Of Breast Conserving Surgery To Preserve The Intercostobrachial Nerve

Objective: As people constantly understand the biological behavior of breast cancer, the concept that breast cancer from the start is a systemic disease has been widely recognized and accepted. Based on the theoretical basis that breast cancer is a systemic disease, breast cancer treatment highlighted the multidisciplinary treatment, which makes less and less surgical resection, and postoperative quality of life become increasingly demanding. By comparing the postoperative situations between the breasts conserving surgeries in breast cancer patients with Axillary Lymph Node Dissection (ALND) to retain ICBN and removal of ICBN, this study investigated the clinical significance of breast conserving therapy to retaining ICBN for patients.Methods: This study choose the 93 patients from North China Coal Medical College Hospital and Union Hospital of Tangshan City during September 2007 to December 2010, who had been operated with ALND breast conserving surgery, which devided ALND into Open and endoscopic ALND, and given conventional radiotherapy and chemotherapy and endocrine treatment. According to whether retained ICBN, the patients were divided into two groups: 62 patients retained ICBN in the operation were as the experimental group and the other 31 patients who resected ICBN were as the control group. This study compared kinds of date between the two groups, including the operation time, blood loss in the operation, the number of ALND, and the situations for the affected arm, underarm skin sensory disturbance and recovery, movement dysfunction and recovery, local tumor recurrence and distant metastasis rate after 1 week, 1 month, 3 months, 6months, 1 year, 2years, 3 years of operation, etc.Results: 1. There is no significant difference between the two groups of retaining ICBN and removing ICBN in operation time, blood loss in the operation and the number of ALND (P >0.05).2. There are statistically significant differences in the upper arm and armpit area after the subjective feeling of the skin abnormalities (χ2=49.663 P=0.000), objective sensory abnormalities(χ~2=34.592 P=0.000), whether the pain (χ~2=45.888 P=0.000), pain level (χ~2=46.930 P=0.000), and the nature of pain(χ~2=46.413 P=0.000); there are statistically significant differences for upper arm and underarm after 1 week, 1 month, 2 months, 3 months, 6 months feeling abnormal reduction in the number of patients(χ~2=9.136 P=0.044) and pain reduction in the number of patients(χ~2=9.662 P=0.048); in the meanwhile, the preservation group and axillary paresthesia in the upper arm of patients 90.6% (10/11) recovered in the short term (3 months), paresthesia resection group of patients recovered less in short-term 31.81% (7/22); 100% of the patients (9/9) in the retention arm and arm pain group recovered in the short term (2 months), the patients in the removal of pain group recovered lower 33.33% (9/27) within 2 months of short-term. There are no obvious difference for limb edema (χ~2=0.052 P=0.974) and the incidences of movement dysfunction (χ~2=0.319 P=0.956).2. There are significant differences between upper arm and underarm in skin paresthesia and the pain incidence: The comparison test by inquiring senses of upper arm and armpit areas on the affected side of patients show that there is significant difference after 1 week, 1 month, 2 months, 3 months, 6 months and longer of operation (P <0.05) and there is no obvious difference in the incidences of movement dysfunction (P >0.05).3. According to following up these two groups of patients in 6-36 months, there is no significant difference in local recurrence rates, metastasis rates, and recent survival rates (P >0.05).Conclusions: Retaining ICBN in breast conserving surgery with ALND for breast cancer patients does not increase the difficulty of surgical operation, does not affect the number of ALDN, and does not increase local recurrence and metastasis rate; it can significantly reduce the skin paresthesia and pain of patients upper arm and underarm areas, and will help patients to improve quality of postoperative life. This shows it has high clinical value.