Surgery for Soft Tissue Sarcomas

Surgery is commonly used to treat soft tissue sarcomas. Depending on the site and size of a sarcoma, surgery might be able to remove the cancer. The goal of surgery is to remove the entire tumor along with at least 1 to 2 cm (less than an inch) of the normal tissue around it. This is to make sure that no cancer cells are left behind. When the removed tissue is looked at under a microscope, the doctor will check to see if cancer is growing in the edges (margins) of the specimen.

• If cancer cells are found at the edges of the removed tissue, it is said to have positive margins. This means that cancer cells may have been left behind. When cancer cells are left after surgery, more treatment − such as radiation or another surgery -- might be needed.
• If cancer isn’t growing into the edges of the tissue removed, it's said to have negative or clear margins. The sarcoma has much less chance of coming back after surgery if it's removed with clear margins. In this case, surgery may be the only treatment needed.

When the tumor is in the abdomen, it can be hard to remove it and enough normal tissue to get clear margins because the tumor could be next to vital organs that can’t be taken out.

Amputation and limb-sparing surgery

In the past, many sarcomas in the arms and legs were treated by removing the limb (amputation). Today, this is rarely needed. Instead, the standard is surgery to remove the tumor without amputation. This is called limb-sparing surgery. A tissue graft or an implant may be used to replace the removed tissue. This might be followed by radiation therapy.

Sometimes, an amputation can’t be avoided. It might be the only way to remove all of the cancer. Other times, key nerves, muscles, bone, and blood vessels would have to be removed along with the cancer. If removing this tissue would mean leaving a limb that doesn't work well or would result in chronic pain, amputation may be the best option.

Surgery if sarcoma has spread

If the sarcoma has spread to distant sites (like the lungs or other organs), all of the cancer will be removed if possible. That includes the original tumor plus the areas of spread. If it isn't possible to remove all of the sarcoma, then surgery may not be done at all.

Most of the time, surgery alone cannot cure a sarcoma once it has spread. But if it has only spread to a few spots in the lung, the metastatic tumors can sometimes be removed. This can cure patients, or at least lead to long-term survival.

Lymph node dissection

If lymph nodes near the tumor are enlarged, cancer may be in them. During surgery, some of the swollen nodes may be sent to the lab and checked for cancer. If cancer is found, the lymph nodes in the area will be removed. Radiation might be used in that area after surgery.

Treatments used with surgery

Sometimes chemotherapy (chemo), radiation, or both may be given before surgery. This is called neoadjuvant treatment. It can be used to shrink the tumor so that it can be removed completely. Chemo or radiation can also be given before surgery to treat high-grade sarcomas when there's a high risk of the cancer spreading.

Chemo and/or radiation may also be used after surgery. This is called adjuvant treatment. The goal is to kill any cancer cells that may be left in the body to lower the risk of the cancer coming back.