Can robotic surgery better preserve sensory function?: The significance and strategy of nerve preservation in axillary lymph node dissection.

Abstract

582 Background: Conventional axillary lymph node dissection (C-ALND) carries a high risk of damaging the intercostobrachial nerve (ICBN), which remains a critical clinical issue affecting both psychological recovery and quality of life in breast cancer patients. While advancements in minimally invasive surgery provide improved visualization and precision, evidence supporting its clinical benefit in preserving sensory function is lacking. Methods: A retrospective analysis was conducted on breast cancer patients who underwent robotic-assisted axillary lymph node dissection (R-ALND, n = 53) and endoscopic-assisted axillary lymph node dissection (E-ALND, n = 58) between 2021 and 2025 (total n = 111). The anatomical integrity of the ICBN (T1-3) was systematically identified and recorded during surgery. Additionally, a blinded evaluator performed standardized bedside sensory testing (BST) on four key ICBN areas (medial upper arm, axilla, upper chest, and lateral chest wall) three months postoperatively, using a scoring system adapted from the ISCIPS consensus group for the current study. A multivariate linear regression model was applied for analysis. Results: Compared with E-ALND, R-ALND demonstrated a significantly higher ICBN-trunk preservation rate (77.4% vs. 63.1%, p = 0.033) and a greater proportion of areas with normal sensation at three months postoperatively (89.2% vs. 74.6%, p = 0.025). Multivariate linear regression revealed that T2-ICBN trunk preservation was the strongest independent predictor of sensory recovery at three months (β = 0.571, 95% CI 0.477–0.664, P < 0.001), with an effect size (standardized β = 0.720) far exceeding other factors. Patients with T2-ICBN preservation achieved a 77.4% rate of completely normal sensation across all four key ICBN areas at three months. After adjusting for variables including T2-ICBN preservation, tumor stage, age and so on, robotic surgery showed a tendency to be an independent protective factor for sensory recovery at 3 months postoperatively compared with endoscopic surgery. (β = 0.110, p = 0.016). Conclusions: Through three-dimensional visualization and tremor-filtering technology, R-ALND significantly reduces the risk of iatrogenic ICBN injury and outperforms E-ALND in preserving short-term postoperative sensory function recovery. In the early phase with a limited learning curve, preserving the ICBN trunk (particularly the T2-ICBN) is recommended to retain most of the patient's sensory function.