Surgery for soft tissue sarcoma

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Most people with soft tissue sarcoma have surgery. The type of surgery you have depends mainly on where the tumour is in the body. When planning surgery, your healthcare team will also consider other factors, such as your overall health.

Surgery may be the only treatment you have or it may be used along with other cancer treatments. You may have surgery to:

• remove all or as much of the tumour as possible
• rebuild the area after the tumour is removed (called reconstruction)
• remove a tumour that has spread to a lung (called lung metastasis)
• reduce pain or ease symptoms (called palliative surgery)

The following types of surgery are used to treat soft tissue sarcoma.

In a wide excision, the surgeon removes the tumour and a small amount of tissue around it (called the surgical margin). A sample of the surgical margin is sent to the lab. If there are no cancer cells in the surgical margin, it’s called a negative surgical margin.

Depending on the amount of tissue removed, your surgeon may need to reconstruct the area where the tumour was removed. This is done at the same time as the surgery to remove the cancer.

Doctors may use other terms for wide excision, such as wide local excision, en bloc resection or wide resection. Itʼs the surgical method used during limb-sparing surgery.

Limb-sparing surgery is often done when a tumour is in a limb. Limb-sparing surgery removes the tumour without removing (amputating) the whole arm or leg (the limb). This type of surgery is also called limb-salvage surgery.

During limb-sparing surgery, the surgeon performs a wide excision to remove all of the tumour. They will also remove any tissue from or near the biopsy site. The surgeon will preserve or protect major nerves or blood vessels so that the limb works as well as possible after surgery.

Depending on the amount of tissue removed, your surgeon may need to do more surgery to replace the tissue and rebuild the limb. This is called reconstruction or reconstructive surgery. Itʼs often done at the same time as the surgery to remove the cancer. Surgeons have different ways that they can reconstruct a limb, using skin, bone, other tissues, and metal implants. They may use the following reconstruction techniques.

A skin graft replaces an area of skin with skin taken from somewhere else on the body. A skin graft can be used to rebuild the area that has had skin removed.

The surgeon removes skin from the donor site, such as the inner thigh or buttock. The skin graft is placed over the area where the cancer was removed and stitched in place. Your healthcare team will tell you how to protect and care for the skin graft while it heals.

A regional flap (also called a local flap) is a piece of tissue, sometimes with skin attached, that contains its own blood supply. One end of the tissue is cut away from the body, while the other end remains attached to maintain the blood supply. The flap is stretched or moved to the wound site from an area close by and stitched in place.

A free flap is a piece of tissue that has been completely removed from the donor site and is moved to the site needing repair. This requires very careful surgery to connect the tiny blood vessels of the flap to the vessels of the surgical wound.

Most soft tissue sarcomas do not spread directly into the bone, so bone doesn’t usually need to be removed. If a bone must be removed for a negative surgical margin, the surgeon may replace it with a bone graft. A bone graft is a piece of bone taken from another part of the body to rebuild the area that has had bone removed. The graft may be taken from your body (called an autograft) or from a donor (called an allograft).

If a bone or bones of a major joint (such as the knee, hip or shoulder) must be removed with the soft tissue sarcoma, an endoprosthesis (prosthetic joint implant) may be used to replace the joint. This allows the joint to move, bend, and hold weight. An endoprosthesis is usually made of metal and plastic.

An amputation is surgery to remove part or all of the arm or leg with the tumour. Most soft tissue sarcomas do not require an amputation. Amputation is mainly needed when the tumour is so large it affects all of the soft tissues around it.

Different types of amputation are done depending on where the tumour is found. Your surgeon and healthcare team will explain the type of amputation that will be done to treat your soft tissue sarcoma.

Most people who have an amputation will use an artificial limb (prosthesis) after surgery. A prosthesis is attached to the end of the limb that was amputated (called the stump).

After surgery, you will have physical rehabilitation and physical therapy. You will have a rehabilitation team to help you recover from your amputation. They will teach you how to use the prosthesis and help you learn to walk or move again.

People who have had an amputation can generally maintain a good quality of life. They can still be physically active and get back to most of their normal activities.

Find out more about rehabilitation after soft tissue sarcoma surgery.

Sometimes surgery is done to remove soft tissue sarcoma that has spread (metastasized) to the lung. Surgery to remove a lung metastasis may be called a lung resection or lung metastasectomy.

The type of surgery that may be offered depends on:

• if the primary cancer can be removed as well
• the number of tumours (also called metastases)
• the size of the tumours
• if the tumours are close to important blood vessels or the spinal cord
• your overall health

Find out more about lung metastases.

Side effects of surgery will depend mainly on the type of surgery and your overall health. Tell your healthcare team if you have any of these side effects, or if you have any others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for soft tissue sarcoma may cause these side effects:

• pain
• swelling
• bleeding
• infection
• wound reopening (separation)
• poor wound healing
• blood clots
• scarring
• weakness or a limp in a limb
• nerve damage

Find out more about surgery and the side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.