Prevalence and risk factors of persistent and neuropathic pain following resection of pediatric extremity soft tissue sarcomas: A nationwide cohort study.
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INTRODUCTION: Resection of extremity soft tissue sarcoma (eSTS) in children carries a substantial risk of chronic postsurgical pain (CPSP) development. However, the exact prevalence and the clinical predictors of CPSP, with and without neuropathic characteristics, remain poorly defined. Therefore, we aimed to quantify outcome after pediatric eSTS surgery and to identify risk factors. METHODS: We extracted data from the Dutch Childhood Cancer Group (DCOG) registry for patients <18 years who underwent eSTS resection between 2003 and 2025. Of 109 patients identified, 78 were evaluable for the analysis of persistent pain and 69 for the analysis of suspected neuropathic pain. Persistent pain was defined as documented pain ≥3 months postoperatively. Suspected neuropathic pain was considered when patient records described burning, tingling, or electric-shock sensations in the operated extremity. At follow-up, cross-sectional questionnaires were distributed to assess persistent pain (NRS) and suspected neuropathic pain (DN4). Predictors of pain outcomes were evaluated using logistic regression analyses. RESULTS: Persistent postoperative pain was documented in 37 of 78 patients (47%), and suspected neuropathic pain in 24 of 69 evaluable patients (35%). Neoadjuvant chemotherapy (OR 3.98; 95% CI 1.47-10.83; p = 0.007) was independently associated with CPSP. Suspected neuropathic pain was more common among patients undergoing intended nerve resection, although this did not reach statistical significance (OR 5.90; 95% CI 0.88-39.66; p = 0.067). Cross-sectional questionnaires were completed by 43 of 62 eligible patients (69%); DN4 scores were consistent with the retrospectively observed prevalence of neuropathic pain. CONCLUSION: Persistent pain affects nearly half of pediatric eSTS survivors, with neuropathic features in over 30%. These findings underscore the need for structured pain assessment and early targeted interventions as part of surgical planning and long-term survivorship care.