Decompressive Surgery in Chemotherapy- and Radiotherapy- Induced Peripheral Compression Neuropathy: A Systematic...

Background: Treatment-related peripheral neuropathies are disabling long-term complications of modern cancer therapy. Chemotherapy-induced peripheral neuropathy (CIPN) and radiation-induced peripheral neuropathy (RIPN) can lead to pain, motor deficits, and sensory loss, substantially impairing quality of life in cancer survivors. Surgical decompression has been proposed as a potential therapeutic option in cases of superimposed focal nerve compression due to treatment-related tissue changes, but evidence remains limited. This systematic review aims to evaluate the indications, surgical techniques, and outcomes of microsurgical decompression for cancer treatment-related peripheral neuropathies. Methods: A systematic search was performed in PubMed and Embase up to July 2026. Studies were screened by two independent researchers, and included when reporting outcomes of surgical intervention for chemotherapy-induced or radiation-induced peripheral neuropathy. Data on patient demographics, oncologic diagnosis, surgical indication, technique, and postoperative subjective and functional outcomes were extracted and presented in tables. Results: Fourteen studies met inclusion criteria describing 95 patients and 120 treated nerves. In CIPN, all surgically treated patients experienced pain relief and improvement in two-point discrimination, without reported deterioration. In RIPN, 88.5% of patients improved in pain, 58.8% in sensory function, and 44.4% in motor strength. Neurolysis combined with vascularized flap reconstruction was associated with better outcomes when compared with neurolysis alone. No major surgical complications were reported. Overall evidence quality was low, with small sample sizes and high heterogeneity among methodologies. Conclusions: Microsurgical decompression with or without vascularized flap reconstruction may provide meaningful pain relief and partial functional recovery in selected patients with treatment-related peripheral compression neuropathies refractory to conservative management. Nevertheless, current evidence is restricted to small retrospective series and case reports.