Surgery for Soft Tissue Sarcoma

Surgery is the most common treatment option for soft tissue sarcoma. The goal of surgery is often to cure the cancer, but surgery might also be used as a palliative treatment if your cancer has spread to distant parts of your body.

Surgery alone may be an option for tumors that are:

• low grade (expected to progress slowly)
• in your extremities or near the surface of your trunk
• 5 cm (1.97 in) or smaller
• removed surgically with no evidence of cancer at the edges of the removed tissue

Healthcare professionals may use radiation therapy or chemotherapy either before or after surgery to help shrink the tumor or to destroy any remaining cancer cells.

Most sarcomas show a poor response to chemotherapy, with response rates reported at 10–50%.

Soft tissue sarcoma surgery types

Surgical options for soft tissue sarcoma include:

• Mohs micrographic surgery: a minimally invasive procedure in which a surgeon cuts the top layer of your skin and examines it for cancer cells, continuing to cut layers until they no longer see signs of cancer
• Wide local excision: the removal of the tumor and at least 1 cm (0.4 in) of tissue around it
• Lymphadenectomy: a surgical procedure in which healthcare professionals remove lymph nodes and examine them under a microscope for cancer
• Amputation: surgery to remove an entire arm or leg

Doctors try to remove as little healthy tissue as possible when performing surgery. Mohs surgery might be an option for treating small tumors in areas where appearance is a concern.

Fewer than 5% of soft tissue sarcoma surgeries are amputations.

Before surgery, you’ll meet with your surgeon to discuss your procedure. You’ll likely undergo an MRI to determine the size and extent of your tumor.

Your surgery will take place at a hospital or a surgery center. The length of your procedure will depend on the exact surgery you’re having, how complicated the tumor is, and other factors.

An anesthesiologist, a surgeon, and nurses will likely be present in your operation room. You’ll likely receive intravenous anesthesia. Your surgical team may use a catheter to drain urine from your bladder, a breathing tube to help you breathe, and an electrocardiogram to track your vitals.

After your surgery, you may need to stay in the hospital for 5–6 days. If you have an amputation, you may need to stay in a hospital for 10–14 days.

The length of your recovery will depend on the extent of your surgery. Your skin might heal in about 2 weeks after Mohs surgery, but swelling after an amputation likely won’t go down for 6–8 weeks.

The 5-year relative survival rates for soft tissue between 2010 and 2016 in the United States were:

In a 2020 study, researchers reported a 14% complication rate in the 30 days after surgery among 1,111 people treated for bone or soft tissue sarcomas of the arms or legs. The most reported complications were:

• infection
• sepsis
• a blood clot in a deep vein (venous thromboembolism)

The risk of death within 30 days of surgery was 0.3%, and one person died during the surgery.

The researchers found that amputation and lower body surgery were associated with the highest complication rates.

In general, other possible complications of surgery include:

• reaction to anesthesia
• heavy bleeding
• damage to organs
• blood clots in your lungs (pulmonary embolism)

Soft tissue sarcoma is a group of cancers that can develop in soft tissues such as muscle, nerves, fat, and blood vessels. Surgery is the most common treatment option for these tumors.

Your tumor may be treatable with surgery alone if it’s small and expected to develop slowly. If your cancer is more advanced, your doctor may recommend radiation therapy or chemotherapy before or after your surgery.