Postoperative Femoral Neuropathy After Oncological Pelvic Surgery: A Case Report and Call for Action

Femoral neuropathy is an uncommon but potentially disabling complication that is well described after gynecologic and colorectal surgery, yet remains poorly characterized following extensive pelvic oncological procedures, despite comparable or greater cumulative risk.We describe a 62-year-old man with type 2 diabetes who developed left-sided femoral neuropathy after open cystoprostatectomy, sigmoid colectomy, cutaneous ureterostomy, and pelvic lymphadenectomy for urachal adenocarcinoma.Postoperatively, he presented with hip flexion and knee extension weakness, anterior and medial thigh/leg hypoesthesia, and an absent patellar reflex.Neurophysiological studies supported the diagnosis of femoral neuropathy and identified an underlying chronic axonal sensorimotor polyneuropathy.A multifactorial injury combining compression, traction, and ischemia related to surgical positioning and exposure, retractor use, and intraoperative hypotension was presumed.Despite structured rehabilitation, partial motor and sensory deficits persisted at the two-year follow-up.This case highlights the importance of awareness and prevention of iatrogenic femoral neuropathy, particularly in high-risk procedures and patients with comorbidities.We present a summary of practical preventive measures and a structured diagnostic and management pathway to support earlier recognition and more consistent care, while also highlighting recurring gaps in perioperative documentation and preoperative neurological assessment that limit diagnostic certainty.