Soft tissue sarcoma surgery

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

June 06, 2022.

Surgery is often the first-line treatment for soft tissue sarcoma. The goal is to remove not only the tumor but also a margin of tissue around it to determine whether remaining cancer cells can be detected after the procedure.

Due to the nature of the disease, it's 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.

The surgeon creates a sarcoma treatment plan depending on the type of sarcoma, the patient's overall health and other factors.

The main forms of surgery for soft tissue sarcomas include those listed below.

Limb-salvage surgery

Limb salvage surgery, also called limb-sparing surgery, is a form of wide local excision, which means the surgeon removes the tumor and some surrounding tissue.

Limb-salvage surgery is often performed if the original tumor is somewhat larger or of a higher grade. During this procedure, the 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 percent to 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's large, or if it's located near important nerves, blood vessels or other critical structures or organs.


Amputation used to be the primary treatment for sarcomas in the extremities. However, 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, surgery may still leave the patient with very limited function, even though a tumor can be safely removed without amputating the extremity. 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. For tumors located inside the chest, thoracoscopic surgery is performed in a similar manner, except the surgery is performed inside the chest wall instead of inside the abdomen.

Reconstructive surgery

For some patients, reconstructive surgery may be performed during the same procedure as the limb-salvage or amputation surgery. An experienced plastic surgeon will play a key role on the surgical team to help with the closure of the surgical incision, in addition to other reconstructive needs the patient may have. 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.

Other surgeries for soft tissue sarcoma

Since soft tissue sarcoma tumors can appear almost anywhere, multiple surgical approaches may be used as a part of the patient's treatment plan.

Open abdominal surgery: For tumors located inside the abdomen where laparoscopic surgery isn’t possible, open abdominal surgery (performed through a larger incision) may be required to remove the tumor.

Thoracic surgery: For chest wall sarcomas, such as a chondrosarcoma, the surgical oncology team will remove the tumor with open chest surgery.

In some cases, sarcomas may 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.

Sentinel lymph node biopsy or lymphadenectomy: 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 also be used to remove metastases if the cancer has spread to the lungs, liver or other organs.

Next topic: What are the facts about soft tissue sarcoma?

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