Soft Tissue Sarcoma Surgery & Surgical Oncology Procedures

Surgery for Soft Tissue Sarcoma

In most cases, surgical removal of sarcoma tumors is a primary therapy, and surgery is a part of most treatment plans. Soft tissue sarcoma surgery can also be combined with chemotherapy and/or radiation treatments before (neoadjuvant therapy) or after (adjuvant therapy) the procedure.

The goal of surgery is to locate and completely remove the soft tissue sarcoma tumor. Our pathologists then examine the tumor to determine whether or not additional treatment is necessary, and to reduce the risk of recurrence.

Due to the nature of the disease, it is essential that soft tissue sarcoma surgery is performed by an experienced surgeon who has worked with these types of tumors before. The surgery requires in-depth planning, and a thorough knowledge of anatomy, as the sarcoma must be removed without disrupting the tumor itself. At each of our Cancer Treatment Centers of America (CTCA) hospitals, we have surgical oncology teams who have experience with soft tissue sarcomas.

Types of Surgery for Soft Tissue Sarcoma

There are several different types of surgery that may be performed for soft tissue sarcomas. The appropriate surgical approach will depend upon variables such as the type of sarcoma, as well as the stage, grade, location and size of the tumor(s).

Wide Local Excision 

A common form of surgery for many types of cancer, wide local excision describes the process of removing a sarcoma tumor with a surrounding margin of healthy, normal tissue. A pathologist will then review the removed tissue under the microscope to determine if the sarcoma tumor has been completely removed. The pathologist may also examine lymph nodes or other tissues removed by the surgical oncologist, to determine if the sarcoma has metastasized (spread). 

Limb-sparing Surgery

Also called limb salvage surgery, this is a form of wide local excision, but implies that the original tumor is somewhat larger or of a higher grade. With limb-sparing surgery, your surgical oncology team aims to remove the entire tumor while avoiding the need to amputate the extremity or rendering it useless by cutting critical nerves or blood vessels.

In about 90-95 percent of sarcoma cases in the United States, the tumor can be removed without amputation. Oftentimes neoadjuvant radiation therapy and/or chemotherapy will be used to shrink the tumor if it is large, or if it is located near important nerves, blood vessels or other critical structures or organs.

Amputation 

For sarcomas located in the extremities, sometimes the limb cannot be spared, and a surgeon will have to remove all or part of the leg or arm. After surgery, the patient is fitted for an artificial prosthesis, and will work with our oncology rehabilitation team to adjust to life after leaving the hospital.

Amputation used to be the primary treatment for sarcomas in the extremities, but advances in surgical techniques, and the use of neoadjuvant radiation therapy and chemotherapy, have provided new treatment options. Currently, amputation is usually reserved for sarcoma cases where essential nerves, arteries or/and muscles have been affected by the tumor, and so the extremity must then be amputated.

In some cases, although a tumor can be safely removed without amputating the extremity, surgery may still leave the patient with very limited function. Therefore, amputation may still be beneficial, since recent advances in prosthetic limbs can provide sarcoma patients with more mobility than leaving a severely impaired extremity in place.

Laparoscopic Surgery

This type of minimally invasive treatment can often be used for gastrointestinal stromal tumors (GISTs), as well as other sarcomas located within the abdomen. Your surgical oncology team will make one or more small incisions, and then use a laparoscope (a long tube with small camera attached to the end) to help guide the removal of the tumor. With smaller incisions, recovery time is often shorter, and you may experience less postoperative pain.

For tumors located inside the chest, thoracoscopic surgery is performed in a similar manner, except the surgery is performed inside of the chest wall instead of inside the abdomen.

Reconstructive Microsurgery

For some patients with soft tissue sarcoma, reconstructive microsurgery may occur during the same procedure as the limb-sparing or amputation surgery. Depending on the size and location of the tumor, the plastic surgeon may take muscle and/or other tissue from another part of the body and place it into the space left by the removal of the tumor.

Lymphadenectomy

Only about 2 percent of soft tissue sarcomas spread to the lymph nodes. In these rare cases, a sentinel lymph node biopsy and/or regional lymphadenectomy may be performed to remove the affected lymph nodes.

Surgery for Metastases 

Surgery may sometimes be used to remove the metastases if the cancer has spread to the lungs, liver or other organs.

Other Surgeries

Since soft tissue sarcoma tumors can appear almost anywhere, there are multiple soft tissue sarcoma surgical approaches that might be used as a part of your treatment plan.  For tumors located inside the abdomen where laparoscopic surgery isn’t possible, open abdominal surgery (surgery performed through a larger incision) will be performed to remove the tumor.  For chest wall sarcomas, such as a chondrosarcoma, your surgical oncology team will remove the tumor with open chest surgery.

In some cases, sarcomas will form inside the chest, near or in the heart, lungs, esophagus or other organs inside the thorax. A thoracic surgeon may be called upon to remove these tumors using either a thoracoscopic or an open approach. Sarcomas of the lung are most often the result of metastasis from another area of the body, as the lungs are the most common location for a sarcoma to spread.

A Team Approach to Soft Tissue Sarcoma Surgery

Soft tissue sarcomas can occur anywhere in the body, which means that the surgical procedure can at times require additional CTCA experts to be present. A vascular surgeon may assist with surgeries that involve major blood vessels, an orthopedic oncologist may become involved if the bones are affected and plastic surgeons can perform reconstructive surgery when necessary. This team approach can limit the number of overall surgeries required, thus shortening your treatment time and your recovery process.

Additionally, if you will be receiving intraoperative radiation therapy (IORT), a radiation oncologist will be present to deliver this treatment during your surgery for soft tissue sarcoma. 

For each soft tissue sarcoma surgical procedure at CTCA, our experts work together to provide appropriate and comprehensive treatments for your individual needs.

Next Topic: Soft Tissue Sarcoma Radiation Therapy