Definition & Overview
Radical resection of soft connective tissue tumours is a surgical method of removing tumour tissue along with the entire muscle or bone compartment surrounding it to greatly reduce the risk of recurrence.
Connective tissue is mainly composed of collagen that provides its elasticity and flexibility. This type of tissue supports and connects as well as separate distinct body parts and organs. Abnormal growth of soft connective tissues can occur virtually anywhere in the body and they can be either benign or malignant. There are several surgical techniques used in removing these tumours. These include intracapsular excision in which the tumour is removed from its pseudocapsule; marginal excision in which the tumour and its surrounding pseudocapsule is removed; and wide excision in which a margin of surrounding healthy tissue is removed along with the tumour and its capsule. However, if the tumour exhibits aggressive growth and is seen to have affected its surrounding parts, the surgeon may perform radical resection that removes the tumour with the entire muscle or bone compartment where it is located. In most cases, this procedure is done to reduce the chances of tumour recurrence.
Who Should Undergo and Expected Results
Despite being mostly asymptomatic, there are instances in which benign soft connective tissue tumours warrant radical resection. Patients diagnosed with lipoma or hemangioma may find that their tumour growth has greatly affected its surrounding body structures and has become a source of pain and discomfort. They may benefit from undergoing radical excision or resection of their tumours. Those who are suffering from leiomyoma, or tumour on the smooth surface of the muscle, may find their mobility impeded by the pain when the abnormal tissue growth has pressed on the muscle tissue. Patients suffering from chondroma or the benign tumour of the cartilage may also be offered this procedure to prevent further deterioration and fractures. The same option may also be offered for those with new bone growth attached to an existing bone.
Patients diagnosed with malignant soft tissue tumours or sarcomas are often advised to undergo radical resection. This is particularly true for those whose tumours are quite aggressive. An example of such condition is liposarcoma, a common tumour affecting the fatty layer in the lower extremities and the gluteal area. This type of tumour often invades its surrounding tissues, hence the need for a more aggressive and radical approach. Those suffering from fibrosarcoma can also benefit from undergoing this procedure. This condition usually occurs in the arms or legs and can metastasize to other parts of the body if left untreated.
Radical resection is also recommended for young adults with synovial cell sarcoma and epitheloid sarcomas, which typically develop in the extremities and can be quite painful. Efforts of saving a limb would often entail removing a large section of the affected part to help avoid total amputation.
Other types of soft connective tissue tumours that can be treated with radical resection include myxoma, mesenchymomas, and alveolar soft-parts sarcoma.
When done on benign tumours, this procedure is quite successful in removing these abnormal mass with relatively low risk of recurrence. Depending on the location and size of the benign mass, patients are typically asked to rest for a day or two. They may also need to adhere to a physical therapy program to promote healing and recover function of the affected parts.
For those with malignant tumour growth, resection could provide a means to stop the spread of cancer cells. However, the success and efficacy of such procedure are largely be dependent on the extent and stage of cancer being treated. Most patients are also asked to undergo radiation therapy and chemotherapy to increase their chances of being completely treated.
How is the Procedure Performed?
Radical resection of soft connective tissue tumours is typically done in a hospital setting with the patient placed under general anaesthesia. The skin of the surgical site is cleansed and sterilised before the surgeon makes an incision to access the tumour site. If the abnormal mass is located within a muscle compartment, the surgeon will have to dissect and remove the entire compartment. The same concept is applied if the tumour is found to be growing on the surface or within a bone. Care must be taken to ensure that there is little injury to nearby blood vessels and nerves as possible. There might also be a need to remove the nearby lymph nodes to help evaluate if the cancer cells have begun spreading to other parts of the body. Once the procedure has removed all indicated body parts, the surgeon then closes the incision with sutures or choose to leave it open. Bone resection may also involve the implantation of prosthesis to fill the gap or hole left behind by the procedure.
Possible Risks and Complications
Patients undergoing radical resection of soft tissue tumours face the risk of:
- Developing adverse reaction to anaesthesia and excessive bleeding during the procedure
- Infection; this can occur if the wound is not kept sterile and the dressing is not regularly replaced
- Losing an organ or body part function, if nearby blood vessels and nerves are damaged or injured. In some cases, this impairment is permanent and patients have to live with a disability after the surgery.
Blood clots and embolism
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Costa MJ, Campman SC, Davis RL. Fine-needle aspiration cytology of sarcoma: retrospective review of diagnostic utility and specificity. Diagn Cytopathol. 1996 Jul. 15(1):23-32.