Postoperative Femoral Nerve Palsy and Meralgia Paresthetica after Gynecologic Oncologic Surgery

Abstract

Femoral nerve palsy and meralgia paresthetica following gynecologic cancer surgery are rare, but severe and long lasting. Here, we aimed to study their incidence, severity, possible risk factors and its time to remission. Between January 2008 and December 2017 976 gynecologic cancer patients were identified in our institutional database receiving surgery. Complete patient charts were reviewed retrospectively. Possible risk factors were analyzed by Fisher's exact test. 441 (45.18%) out 976 were treated for Ovarian cancer. In total 23 patients were identified with a postoperative neurological leg disorder. A femoral nerve palsy was present in 15 patients (1.5%) and a meralgia paresthetica in 8 patients (0.82%). Three patients showed both disorders. Duration of surgery (p = 0.0000), positioning during surgery (p = 0.0040), femoral artery catheter (p = 0.0051), prior chemotherapy (p = 0.0007), nicotine abuse (p = 0.00456) and prior polyneuropathy (p = 0.0181) showed a significant association with a postoperative femoral nerve palsy. Nicotine abuse (p = 0.0335) and prior chemotherapy (p = 0.0151) were significant for the development of a meralgia paresthetica. Long lasting surgery, patient positioning and femoral arterial catheter placement are risk factors for a postoperative femoral nerve palsy in gynecologic cancer surgery. Polyneuropathy, nicotine abuse, and prior chemotherapy are predisposing risk factors for a femoral nerve palsy and a meralgia paresthetica. A resolution of symptoms is the rule for both disorders within different time schedules.

Keywords: femoral nerve; femoral nerve palsy; iatrogenic nerve injury; meralgia paresthetica.

Figure 1

Anatomical route of the femoral nerve. Femoral nerve (yellow arrow), psoas muscle (red star) and illiacus muscle (pink star). A/B/C axial contrast-enhanced CT scans showing the course of the femoral nerve in between the psoas and iliacus muscle (A) and running lateral to the femoral artery and vein (B,C). (D,E) coronal contrast-enhanced CT scans showing the course of the femoral nerve in between the illiacus muscle and the psoas muscle and lateral to the fermoral artery and vein.(F) saggital contrast-enhanced CT scans showing the nerve just below the inguinal ligament.

Figure 2

Retractor blades; cranial: old blades; caudal: individually reshaped new blades.