Effect Of Preserving Intercostobrachial Nerve On Post-mastectomy Pain Syndrome And Prognosis

Objectives To investigate the effect of preserving intercostobrachial nerve on post-mastectomy pain syndrome and prognosis in modified radical mastectomy of patients with breast cancer.Methods The clinical data of 370 patients undergoing radical mastectomy for breast cancer who underwent surgery in the department of oncology surgery of Affiliated Hospital of North China University of Science and Technology from July 2005 to September 2012 were retrospectively analyzed.Among them,there are 81 cases in the group with the intercostobrachial nerve preserved,and 310 cases in the group with the intercostobrachial nerve resected.The age,BMI,pathological stage,operative time,intraoperative blood loss and number of lymph node dissection were compared between the two groups.The differences of the incidence of PMPS,sensory disturbances,and local recurrence and distant metastasis between the two groups after 1 year,3 and 5 years of operation were analyzed.To discuss the difference between postoperative SF-MPQ pain questionnaire score,features of pain and postoperative survival and health status(combined with SF-36 profile)in patients with PMPS.To perform survival analysis by survival curves.Results 1 The operation time,intraoperative blood loss and the number of lymph node dissection in the two groups were similar,with no statistically significant difference(t=-1.76,P=0.079;t=-1.14,P=0.255;t=-1.39,P=0.163);2 Follow-up 1,3 and 5 years after operation,the incidence of PMPS in the preservation group of intercostobrachial nerve was significantly lower than that in the resection group of intercostobrachial nerve,and the difference was with statistically significant difference(?~2=8.85,P=0.003;?~2=9.13,P=0.003;?~2=7.26,P=0.007),however,the pain characteristics and description items of PMPS were similar,with no statistically significant difference.3 Follow-up 1,3 and 5 years after operation,the incidence of sensory disturbances in patients with preservation group of intercostobrachial nerve was also significantly lower than that in the resection group with statistical difference(?~2=14.44,P=0.000;?~2=17.74,P=0.000;?~2=10.13,P=0.001);4 The scores of SF-MPQ pain questionnaire of intercostobrachial nerve preservation group after operation were significantly lower than that of resection group,and the difference was statistically significant(t=-21.07,P=0.000);5 The score of survival health status of all the items described in SF-36 short form of preservation group were significantly higher than that of resection group except physical health and social function,and the difference was statistically significant(t=13.08,P=0.000;t=22.83,P=0.000;t=13.77,P=0.001;t=18.88,P=0.000;t=4.96,P=0.000;t=8.18,P=0.000;t=0.29,P=0.495;t=-4.77,P=0.241);6However,the incidences of local recurrence and distant metastasis in the two groups were similar,with no statistically significant difference after 1 year,3 and 5 years after surgery(?~2=0.202,P=0.653;?~2=0.037,P=0.847;?~2=0.059,P=0.809;?~2=0.033,P=0.856;?~2=0.224,P=0.636;?~2=0.180,P=0.671);7 The Kaplan-Meier survival curves of the two groups showed similar trends,but there was no statistically significant difference in the 3-year and 5-year survival rates after operation between the preservation group and the resection group(?~2=0.011,P=0.918;?~2=0.227,P=0.634).Conclusions 1 The preservation of intercostobrachial nerve in modified radical mastectomy can effectively reduce the incidence of PMPS and sensory disturbance and improve the postoperative quality of life and health.2 The preservation of intercostobrachial nerve in modified radical mastectomy could significantly reduce the degree of pain and overall pain status of PMPS compared with non-preservation of intercostobrachial nerve,and the preservation of intercostobrachial nerve does not affect the characteristics and nature of pain in patients.3 The preservation of intercostobrachial nerve in modified radical mastectomy does not affect the long-term survival of patients after surgery compared to the resection of it.4 The preservation of intercostobrachial nerve in modified radical mastectomy does not affect the operation time,intraoperative blood loss,lymph node dissection number,local recurrence rate and distant metastasis rate.