Morbidity associated with axillary surgery for breast cancer

To determine the prevalence of long-term complications of axillary surgery for breast cancer and whether preservation of the intercostobrachial nerve (ICBN) reduces this morbidity.

A self-administered questionnaire was mailed to all patients who had undergone breast cancer and axillary surgery 2.5-6 years previously. The questions addressed symptoms of arm pain, numbness, weakness, stiffness and swelling. The operation notes were reviewed to ascertain the type and extent of surgery and whether the ICBN was preserved or sacrificed.

One hundred and seventy of 208 (82%) questionnaires were returned completed. At least one symptom was reported by 130 (76.5%) of patients. Numbness was the most common symptom, present in 60% overall. Patients who had had the ICBN preserved reported significantly less numbness (37.5%vs 71.7% (P < 0.001)). Pain was present in 45.3% of patients and those with the ICBN preserved had significantly less pain (31.3%vs 58.5% (P = 0.02)). Weakness was present in 40%. Swelling was reported in 26.4% and stiffness in 12.2%.

Axillary lymph node dissection for breast cancer has a high long-term morbidity. Preservation of the ICBN during the axillary procedure significantly reduces this morbidity.