Park Jong Woong, Kim Han-Soo, Yun Ji Yeon, Han Ilkyu
Department of Orthopaedic Surgery, Seoul National University Hospital, Daehak-ro, Jongno-gu, Seoul, Korea Orthopaedic Oncology Clinic, National Cancer Center, Ilsan-ro, Ilsandong-gu, Goyang, Korea Department of Orthopaedic Surgery, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, Korea.
Medicine (Baltimore). 2018 May;97(21):e10852. doi: 10.1097/MD.0000000000010852.
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.
肉瘤手术常因解剖操作频繁侵犯神经平面而导致神经损伤。神经损伤可能引发神经性疼痛（NP），进而导致术后持续疼痛。这是第一项调查接受四肢或骨盆肉瘤手术患者术后NP患病率及相关因素的研究。纳入在就诊前至少6个月接受了根治性手术且组织学确诊为肉瘤的患者（n = 144）。通过使用PainDetect（一种广泛用于检测NP的问卷）评估NP的存在情况。PainDetect评分≥13的患者被认为患有NP。研究了可能与NP发生相关的因素：患者特征、肿瘤特征、手术范围和辅助治疗。144例患者中，36例（25%）患有NP。与无NP的患者相比，患有NP的患者视觉模拟量表评分（P <.001）、多伦多肢体挽救评分（P <.001）和肌肉骨骼肿瘤学会评级量表评分（P <.001）明显更差。在与NP相关的可能因素中，与无NP的患者相比，患有NP的患者更有可能接受了盆腔手术（P =.002）和多次手术（P =.014）。在逻辑回归分析中，盆腔手术（比值比 = 5.05，P =.005）和多次手术（比值比 = 2.33，P =.038）是肉瘤手术后与NP相关的独立因素。这项研究表明，肉瘤手术后NP的患病率相当高。盆腔手术和多次手术可预测术后持续性NP。
