Soft Tissue Sarcoma: Surgery
Surgery is often part of the treatment plan for soft tissue sarcoma. Different kinds
of surgery may be done. Which type you have depends on where the cancer is, how big
it is, how much it has spread, and other factors.
When might surgery be used for soft tissue sarcoma?
Surgery is often the main treatment for soft tissue sarcomas. For cancers that are
small and are still only in the place where they started, this might be the only treatment
needed. The goal of surgery is to remove all of the cancer while keeping as much of
the normal function of the affected area as possible. In most cases, a small area
(margin) of normal tissue around the tumor is also removed. This is to increase the
chances of removing all of the cancer.
Some tumors can't be fully taken out. They may be too large. Or they may be very near
important structures. In these cases, other treatments may be done first to try to
shrink the tumor. These can include radiation therapy or chemotherapy or both. These
treatments are also sometimes used after surgery to try to kill any cancer cells that
are left.
If the cancer has spread to other parts of the body (such as your lungs), you may
still need surgery. In these cases, your healthcare provider will advise surgery if
they think all of the cancer can be removed.
Surgery for soft tissue sarcoma is often a complex surgery. It can have major side
effects. So it’s important that you understand it and are healthy enough for it. It’s
also important to have it done at a center that has experience treating this cancer.
Types of surgery for soft tissue sarcoma
For tumors on an arm or leg
Limb-sparing surgery
Most sarcomas on an arm or leg can be treated with limb-sparing surgery. In this surgery,
the surgeon removes the tumor and margin of normal tissue. But they try to keep as
much of the limb's function and appearance as possible. Other treatments, such as
radiation, might be done after this type of surgery.
Amputation
If the tumor is large or near important structures, your surgeon may not be able to
keep the limb's function when removing the tumor. In this case, the best choice might
be to remove (amputate) the limb. How much of the limb will be amputated depends on
where the tumor is. Amputation is used less often than in the past. This is because
surgeons have gotten better at doing limb-sparing procedures.
For tumors in other parts of the body
Soft tissue sarcomas can sometimes form in other parts of the body. These can include
the head and neck area, inside the chest, or in the belly (abdomen). The type of surgery
used to treat these tumors depends on where they are, how big they are, and how close
they are to nearby important structures.
If you have any questions or concerns about surgery for your sarcoma, talk with your
healthcare provider about what will be done and what to expect.
Possible risks and complications of surgery
All surgery has risks. Some of the risks of any major surgery include:
Risks from surgery for soft tissue sarcoma
Along with the risks above, sarcoma surgery can sometimes cause other problems. These
can include:
-
Loss of function in the area where the tumor was removed. This might be short-term
(temporary) or lifelong (permanent).
-
Not being able to drive, lift, cook, or do other daily tasks until you heal
-
Long-term (chronic) swelling of your arm or leg (lymphedema)
Getting ready for your surgery
Before you go for surgery, you’ll meet with your surgeon to talk about it. At this
time, you can ask any questions and discuss any concerns you may have. This is also
a good time to go over the possible side effects of the surgery and to talk about
its risks. You might ask if the surgery will affect how you function, and what your
scars will look like. You might also want to ask if you’ll need rehab (rehabilitation)
after surgery, and when you can return to your normal activities and work. After you
have discussed all the details with the surgeon, you’ll sign a consent form for the
surgery. This gives your healthcare provider permission to do the surgery.
A few days before your surgery, your healthcare provider might prescribe laxatives
and enemas to help clean out your colon. Your provider will tell you when and how
to use these. You may also be told to follow a special diet.
On the day of your surgery, you should arrive at the hospital admission area as directed.
This is often a few hours before your surgery is supposed to start. There you'll finish
the needed paperwork and then go to a preoperative area. In this area, you’ll undress
and put on a hospital gown. Your healthcare providers will ask you about your past
health history and allergies. They will also talk about the upcoming surgery. Try
not to get frustrated by the repetition. These questions are repeated to help prevent
mistakes.
While you’re in the preoperative area, an anesthesiologist or a nurse anesthetist
will do an evaluation. They will explain the medicine (anesthesia) you’ll have during
your surgery. It will put you to sleep so that you won't feel any pain during the
surgery. Answer all the questions thoroughly and honestly. This will help prevent
complications. Also ask any questions you have. You’ll sign an anesthesia consent
form that states that you understand the risks involved and gives the healthcare provider
permission to give you anesthesia.
Your surgeon will also see you in the preoperative area. You can ask any last-minute
questions you have. This can help put your mind at ease.
What to expect during surgery
When it’s time for your surgery, you’ll be taken into the operating room. There will
be many people there. These include the anesthesiologist, surgeon, and several nurses.
To make sure of sterility, everyone will be wearing a surgical gown and a face mask.
Once in the room, medical staff will move you onto the operating table. Your anesthesiologist
or nurse will place an IV (intravenous) line into your arm. This needs just a small
skin prick. Sometimes the IV may be started in the preoperative area instead. Someone
might place special stockings on your legs to help prevent blood clots. ECG (electrocardiogram)
wires with small, sticky pads on the end will be attached to your chest to keep track
of your heart. You’ll have a blood pressure cuff wrapped around your arm. When all
the preparation is done, you’ll get the anesthetic through the IV and will fall asleep.
During surgery, your healthcare provider may put a small hollow tube (catheter) through
your urethra and into your bladder to drain urine. You’ll also have a breathing tube
placed in your windpipe (trachea). A breathing machine will control your breathing. Also,
a nasogastric (NG) tube may be placed in your nose. This is a suction tube that goes
into the stomach to drain stomach contents.
What is removed during surgery and where your cuts (incisions) are depend on the type
of surgery you have. This is based on where the tumor is.
After your surgery is done, you will be moved to the PACU (postanesthesia care unit)
to watch your condition for another hour or two. When you wake up, don't be alarmed
by the number of tubes and wires attached to you. These are normal postsurgery monitors.
When you’re fully awake and stable in the PACU, your loved ones may be able to see
you for a short time. Once you remain awake and stabilized, the staff will move you
to a regular hospital room.
What to expect after surgery
When you first wake up, you might have some pain. Your healthcare provider will give
you pain relievers as needed to help you feel more comfortable. The pain medicines
will also help you get up and move around the day after your surgery. This is important
for your recovery.
It will take you time to get back to eating normally and having regular bowel movements.
You may still have the small catheter in your bladder to drain urine. This lets your healthcare
providers measure your urine output. This helps keep track of your fluid status. It’s
normally taken out before you go home.
How long you stay in the hospital will depend on the type of surgery you have. You
can slowly return to most normal activities once you leave the hospital. But don't
lift heavy things for several weeks. Always follow the instructions from your healthcare
provider. Depending on the type and location of your surgery, you may have a referral
to start rehab with physical therapy and occupational therapy.
After surgery, you may feel weak or tired for a while. The amount of time it takes
to recover from a surgery is different for each person. But you likely won’t feel
like yourself for several months. Your provider will tell you how to care for your
surgical incisions. They will tell you when you can bathe or shower. You likely won't
be able to drive for a while, especially if you are taking certain pain medicines.
Talk with your healthcare team
If you have any questions about your surgery, talk with your healthcare team. They
can help you know what to expect before, during, and after your surgery.