Definition & Overview
Soft tissue sarcoma resection is one of the methods considered for the treatment of cancer that affects the body's soft tissues including the muscles, lymph and blood vessels, tendons, and tissues surrounding the joints. At times, this condition has no perceived signs or symptoms until the growth has gotten bigger and has affected the surrounding tissues and other body parts. Though most of the soft tissue sarcomas develop in the arms and legs, the condition can also affect other body parts, including internal organs like the stomach and the uterus.
Apart from surgery, this type of cancer can be treated using other modalities that include radiotherapy and chemotherapy. When needed, the patient is advised to try a combination of these treatments to achieve optimal results.
Who Should Undergo and Expected Results
The procedure can be recommended for patients diagnosed with:
- Soft tissue sarcoma, which afflicts both adults and children, and is even known to occur among infants
- Adult fibrosarcoma, which is characterised by cancer growth in the fibrous tissues of the trunk, arms, and legs
- Angiosarcoma, a type of sarcoma that develops in the lymph or blood vessels. Some patients develop this condition after a certain part of the body has been subjected to radiotherapy for other unrelated condition, like breast cancer.
- Malignant tumour growth under the skin, called epitheloid sarcoma, and in fat tissues, called liposarcomas. The former can occur in almost any part of the body while the latter typically develops behind the knees, abdomen, and thighs.
- Synovial sarcoma, a condition in which malignant growth typically occurs in tissues located around the joint in the knee, shoulder, ankle, and hip
- Desmoplastic small round cell tumour, clear cell sarcoma, and malignant mesenchymoma
Patients who undergo this surgical procedure have to stay in the hospital for several days for close monitoring but are able to resume normal activities after a few weeks.
The outcome of soft tissue sarcoma resection depends on several factors. These include the location and size of the tumour at the time of diagnosis, possible spread to other parts of the body, the depth of tumour, and the grade of cellular appearance under the microscope. The resection of small-sized tumours that has not yet metastasized generally has a good prognosis with some patients achieving complete cure following surgery, especially those with tumours located near the surface of the body. Surgery for localised sarcoma has high survival rate, especially if the cancer is in early stages.
How is the Procedure Performed?
Soft tissue sarcoma resection is considered a major surgical procedure, with the patient placed under general anaesthesia. The surgeon marks the surgical site and makes one or more incision to expose the tissue where the sarcoma is embedded. One of the most common techniques employed is the wide local excision, which involves the removal of cancer growth and about 2 inches of healthy tissue surrounding the malignant cells. Removing an extra margin of surrounding cells would help reduce the chances of the sarcoma from recurring. The incision is then closed with sutures.
Sarcomas located in the limbs may also be removed surgically without removing a big part of the arm or leg. This is termed limp sparing surgery and is typically preferred over the previous practice of amputating the whole limb following diagnosis. In some cases where there is a recurrence, the whole limb may need to be removed to increase the patient’s chances of survival.
Possible Risks and Complications
As a major surgery, soft tissue sarcoma resection carries various risk and possible complications, including:
- Adverse reactions to anaesthesia
- Extensive bleeding in the surgical site
- Formation of blood clots
- Nerve damage, which can lead to chronic pain and numbness in the affected area
- Oedema, or swelling in the limbs
- ‘Phantom limb’ phenomena - Those who underwent complete limb amputation may experience this and would still feel the missing limb
DeLaney TF, Spiro IJ, Suit HD, Gebhardt MC, Hornicek FJ, Mankin HJ, et al. Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. Int J Radiat Oncol Biol Phys. 2003 Jul 15. 56(4):1117-27
Judson I, Verweij J, Gelderblom H, Hartmann JT, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol. 2014 Apr. 15 (4):415-23.