P111 Femoral neuropathy after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: why does this happen?

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Femoral neuropathy is an uncommon complication associated with abdominal and pelvic surgical procedures, including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Prolonged lithotomy positioning and compression by retractors are typical causes, with limited evidence regarding the role of intraoperative chemotherapy agents. <h3>Methods</h3> We report a case of a 57-year-old woman with adenocarcinoma of the cecum with peritoneal carcinomatosis. She underwent neoadjuvant chemotherapy prior to surgery with FOLFOXIRI, experiencing paresthesias in the extremities. Subsequently, she underwent cytoreductive surgery and HIPEC under general anesthesia combined with an epidural block, along with intra-abdominal instillation of mitomycin-C for 60 minutes. The surgery lasted 7 hours. <h3>Results</h3> After surgery, the patient experienced decreased muscle strength in the right lower limb, inability to flex the thigh but maintaining dorsiflexion and plantar flexion, along with paresthesias in the anterior thigh and leg. The epidural catheter was removed, and she underwent lumbar and cranial computed tomography scans, which showed no significant alterations. Subsequently, electromyography revealed findings consistent with neurogenic compromise in the territory of the right femoral nerve. Due to persistent symptoms, she initiated physical therapy and was subsequently referred to a rehabilitation unit upon discharge. <h3>Conclusions</h3> Despite being documented in the literature, the etiology of perioperative femoral neuropraxia, remains uncertain. Risk factors include positioning, duration of surgery, prior chemotherapy, and pre-existing polyneuropathy, with the possibility of intra-abdominal chemotherapy contributing to neuropathic injury. Further research is warranted to elucidate the mechanisms underlying femoral neuropathy in this context, raising the possibility of a multifactorial etiology.