Neuropathic pain after sarcoma surgery: Prevalence and predisposing factors

Surgery for sarcoma frequently causes nerve damage as the dissection often violates the internervous plane. Nerve damage may cause neuropathic pain (NP), which can result in persistent pain after surgery. This is the first study to investigate the prevalence and associated factors of postoperative NP in patients who underwent surgery for sarcoma of the extremities or pelvis. Patients (n = 144) who underwent curative surgery at least 6 months prior to the visit for histologically confirmed sarcoma were enrolled. The presence of NP was assessed by administering PainDetect, a widely used questionnaire for detecting NP. Patients with PainDetect scores ≥13 were considered to have NP. The possible factors that might be associated with the development of NP were investigated: patient characteristics, tumor characteristics, extent of surgery, and adjuvant therapy. Out of 144 patients, 36 patients (25%) had NP. Patients with NP had significantly worse visual analog scale score (P < .001), Toronto Extremity Salvage Score (P < .001), and Musculoskeletal Tumor Society Rating Scale score (P < .001) than patients without NP. Among the possible factors associated with NP, patients with NP were more likely to have undergone pelvic surgery (P = .002) and multiple surgeries (P = .014) than patients without NP. In logistic regression analysis, pelvic surgery (odds ratio = 5.05, P = .005) and multiple surgeries (odds ratio = 2.33, P = .038) were independent factors associated with NP after sarcoma surgery. This study suggests that the prevalence of NP after surgery for sarcoma is considerable. Surgery of the pelvis and multiple surgeries are predictive of postoperative persistent NP.