Soft Tissue Sarcoma: Surgery
Surgery is often part of the treatment 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 preserving as much of the normal function of the affected area as possible. In most cases, a small margin of normal tissue around the tumor is also removed to increase the chances of removing all of the cancer.
For tumors that cannot be fully taken out because they are too large or are very near important structures, 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 do surgery if he or she thinks all of the cancer can be removed.
Surgery for soft tissue sarcoma is often a complex operation. 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
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 he or she tries to preserve as much of the limb's function and appearance as possible. Other treatments, such as radiation, might be done after this type of surgery.
If the tumor is large or near important structures, your surgeon may be able to preserve limb function when removing the tumor. In this case, the best option might be to remove (amputate) the limb. The extent of the amputation 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 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 to 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
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 the following:
Loss of function in the area where the tumor was removed. This might be temporary or permanent.
Not being able to drive, lift, cook, or do other daily tasks until you heal
Chronic swelling of your arm or leg
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 review 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 rehabilitation, and when you can expect to return to your normal activities. After you have discussed all the details with the surgeon, you’ll sign a consent form that says that your healthcare provider can do the surgery.
A few days before your surgery, your healthcare provider might prescribe laxatives and enemas to help clean out your colon. Your healthcare 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 a couple of hours before the time your surgery is supposed to start. There, you'll complete the needed paperwork and then go to a preoperative area. In this area, you’ll undress and put on a hospital gown. During this time 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 and explain the anesthesia you’ll have during your surgery. The purpose of the anesthesia is to put you to sleep so that you won't feel any pain during the operation. Be sure to answer all the questions thoroughly and honestly. This will help prevent complications. Also, ask any questions you have about your anesthesia. You’ll sign a form that states that you understand the risks involved.
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 ensure 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. There your anesthesiologist or nurse will place an intravenous line (IV) into your arm. This requires 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. EKG wires with small, sticky pads on the end will be attached to your chest to monitor your heart. You’ll have a blood pressure cuff wrapped around your arm. When all the preparation is done, you’ll receive the anesthetic through the IV and will fall asleep.
During surgery, your healthcare provider may put a Foley catheter through your urethra and into your bladder. This is a hollow tube used to drain urine. You’ll also have a breathing tube placed in your windpipe. A breathing machine will control your breathing. Also, a nasogastric 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 incisions are depend on the type of surgery you have. This is based on where the tumor is.
After your surgery is done, medical staff will move you to the recovery room. There, staff will watch you 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 postoperative monitors. When you’re fully awake in the recovery room, your family will be able to see you for a short time. Once you’re awake and stabilized, the staff will transfer you to the regular hospital floor.
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’ll still have the Foley catheter in your bladder to drain urine. It allows your healthcare providers to 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 you should avoid lifting heavy things for several weeks. Always follow the instructions you get from your healthcare provider.
After surgery, you may feel weak or tired for a while. The amount of time it takes to recover from an operation is different for each person. But you likely won’t feel like yourself for several months. Your healthcare provider will give you instructions about whether and when you can get your incisions wet. You likely won't be able to drive for a while, as directed by your healthcare providers.
Talk to your healthcare team
If you have any questions about your operation, be sure to talk to your healthcare team. They can help you know what to expect before, during, and after your surgery.
March 21, 2017
Alteri, Rick, MD,Levin, Mark, MD