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Soft tissue sarcoma

Surgery for soft tissue sarcoma

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 Cancer Treatment Centers of America® (CTCA) hospital, we have surgical oncology teams who have experience with soft tissue sarcomas.

The main forms of surgery for soft tissue sarcomas are:

Wide local incision: Limb-sparing surgery, also called limb salvage surgery, is a form of wide local excision. This type of surgery 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: 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. 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 surgery: For some patients, reconstructive surgery may be performed during the same procedure as the limb-sparing 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.

Since soft tissue sarcoma tumors can appear almost anywhere, multiple soft tissue sarcoma surgical approaches may 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.

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