• Sanjay Warrier, Sang Hwang, Cherry E Koh, Heather Shepherd, Cindy Mak, Hugh Carmalt, and Michael Solomon.
• Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; University of Sydney, Camperdown, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Department of Surgery, Prince of Wales Hospital, Randwick, NSW, Australia. Electronic address: drsanjaywarrier@hotmail.com.
• Breast. 2014 Aug 1; 23 (4): 310-6.

PurposeManagement of the ICBN during axillary dissection is controversial and the division of ICBN is often trivialised. The effect of dividing the ICBN, and its association with sensory disturbance, is unclear. A systematic review and meta-analysis was performed to evaluate the effect of preserving the ICBN during axillary dissection.MethodsA systematic literature review and meta-analysis is performed according to the PRISMA and Cochrane Collaboration guidelines.ResultsThree RCTs and four non-RCTs were reviewed. A meta-analysis demonstrated that the incidence of sensory disturbance was significantly lower with preservation of ICBN compared to division of the ICBN with Mantel-Haenzel combined odds ratio 0.31 (0.17-0.57, 95% CI). There was relatively low level of heterogeneity (I(2) = 19%, χ(2) = 2.48, df = 2). The sensory disturbance was more likely to be hyposensitivity when compared to hypersensitivity (p < 0.0001). No difference on number of lymph nodes dissected or operating time was noted.ConclusionThis meta-analysis demonstrates that division of the ICBN is associated with higher risk of sensory disturbance, and that the nature of this sensory disturbance is more likely to be hyposensitivity, attributable to reduced nerve function.Copyright © 2014 Elsevier Ltd. All rights reserved.

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