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:

• Reactions to anesthesia

• Heavy bleeding

• Blood clots in the legs or lungs

• Damage to nearby organs

• Infection at the surgery site

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.