Surgery for soft tissue sarcoma

Soft tissue sarcomas are rare, so surgery is done by a surgeon who specialises in treating them. The surgeon is part of a multidisciplinary team (MDT) and based in a specialist sarcoma unit.

You may have a lump removed and only find out it is a soft tissue sarcoma after the surgery. In this situation, you will be referred to a sarcoma specialist who is part of an MDT after your initial surgery.

The aim of most sarcoma surgery is to remove all of the tumour. Usually, an operation called a wide local excision is done. This means the surgeon removes the tumour, along with an area (margin) of healthy, cancer-free tissue around it.

After the operation, the pathologist examines the tissue from the margin. If there are cancerous cells in the margin, you may need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back.

The aim of most sarcoma surgery is to remove all of the tumour. Usually, an operation called a wide local excision is done. This is when the surgeon removes the tumour, along with an area of healthy, cancer-free tissue around it. This area is called a margin.

After the operation, a specialist called a pathologist examines the tissue from the margin. If there are cancerous cells in the margin, you may need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back.

The type of operation you have will depend on where the sarcoma is. You may have other treatments before or after surgery or both.

It is usually possible to remove a soft tissue sarcoma in an arm or leg without having to remove the whole limb. This is called limb-sparing surgery. It is often done by using a combination of surgery, radiotherapy and occasionally chemotherapy.

We have more detailed information about what to expect before and after limb-sparing surgery.

Rarely, the best treatment option is to remove the affected limb to make sure all the cancer has been removed. This is called amputation.

Depending on the size and position of the sarcoma, the surgeon may have to remove a large area of tissue. This may include important nerves and blood vessels. You may need to have surgery to reconstruct the area. This is done at the same time as your operation, usually by a plastic surgeon.

The aims of reconstructive surgery are to:

• make the area look and work as naturally as possible
• pad and protect important tissue nearby
• help the wound to heal.

The operation will depend on where in your body the sarcoma is and how much tissue the surgeon needs to remove. If it is a smaller area, the surgeon may be able to join the 2 edges together again. For larger areas, they may need to use a skin graft or tissue flap.

Sometimes, plastic surgeons need to use a specialist technique to repair the operation site. They use a slightly thicker layer of skin and tissue than for a skin graft. This is called a tissue flap. Tissue flaps include fat and muscle. The different types of tissue flap include the following:

• A local flap uses tissue from an area close to where the cancer has been removed.
• A pedicle flap uses tissue from an area further away, but close enough to keep the flap connected to its original blood supply.
• A free flap uses tissue that has been completely removed from another part of the body, along with its blood vessels.

The surgeon and specialist nurse will explain your operation and answer any questions you have.

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