Types of sarcoma surgery

Surgery is the main treatment for most primary soft tissue sarcomas. It is very specialised treatment. You should be treated at a major hospital that has surgeons who are trained and very experienced in this type of surgery.

The aim of most sarcoma surgery is to completely remove the tumour. The most common operation is a ‘wide local excision’. This means removing the cancer with a border of healthy tissue around it. Having a border of healthy tissue with no cancer cells helps the surgeons to be sure they have removed all the cancer. This lowers the risk of the cancer coming back.

It is difficult to give general information about sarcoma surgery. The type of operation you have will depend on where in your body the sarcoma is. Many sarcomas are in the arm or leg. But they can start anywhere in the body. For example, leiomyosarcoma can grow in the womb (uterus). If you have this type of cancer, it may be necessary to remove your womb. This is called a hysterectomy. In the cervical cancer section of CancerHelp UK there is information about having a hysterectomy. You may want to look at this information. But it is important to remember that sarcomas are very different to cervical cancer and so it is only information about the basic hysterectomy operation that will apply to you.

If your tumour is in an arm or leg, you may be able to have limb sparing surgery. This means removing just the cancer and a surrounding area of healthy tissue. You will be in hospital for about 7 to 10 days after this type of surgery. Unless you have a low grade sarcoma, your doctor will want you to have radiotherapy after your wound has healed (about 6 weeks later). This is done to try to stop the cancer coming back. If it does come back, you will have another operation to remove more tissue, and may have to go on to have your arm of leg removed (amputation) in the future.

While your wound is healing, you may want a waterproof cover for your arm or leg, so that you can have a bath, shower or even go swimming without getting it wet.

Sometimes the only way to completely get rid of a sarcoma is to remove the whole limb or a part of the limb where the sarcoma is growing. Or, occasionally amputation is needed because a sarcoma has come back in the same limb after previous limb-sparing surgery.

If you have to have an amputation, you should have access to a specialist team of doctors, nurses and physiotherapists - a multidisciplinary team. They will help you before your operation and with your recovery and rehabilitation afterwards. Psychological support can be very important. If you have to have a limb removed you are likely to have many strong feelings. It affects your body image (the way you see yourself). Talk to your doctors and nurses about the support services that are available to you. There are also support groups who may be useful to you before and after surgery.

During some operations for soft tissue sarcoma the surgeon has to take away quite a lot of tissue. So you may need some plastic surgery to repair the area. This happens at the same time as your sarcoma operation. The exact operation you have will be unique to you. It will depend on where in the body you have the sarcoma and how much tissue the surgeon has to remove. So it isn't possible to give very many details here.

Whichever type of plastic surgery operation you have, the surgeon's main aim will be to give you a result that is as natural looking as possible and that works as normally as possible.

With smaller sarcoma operations, the surgeon may just be able to pull the underlying tissues together and stitch them together. But sometimes, there isn't enough healthy skin to use, so the surgeon needs a skin graft to repair the surface. A skin graft uses a strip of skin taken from another part of your body. The area where the skin is removed is called a 'donor site'. The donor site heals itself over the few weeks following your operation. The repair site, where the donor skin goes, will also heal but will be more delicate and may take longer.

To repair a larger area, your plastic surgeon may need to use a specialist technique called a 'tissue flap'. There are several types of flap repair. The area of the sarcoma and the size of the wound will determine which type your surgeon needs to use. A local flap means that tissue next to the wound is used to repair it. A pedicle flap is a flap taken from a little further away, but close enough to leave the flap's original blood supply connected.

A 'free flap' is a transplant of tissue from one part of your body to another. The tissues under the skin are taken from the donor site, as well as the skin. The flap of tissue and skin is removed with its own blood vessels. The surgeon connects the blood vessels up in the new site, so that the flap has a good blood supply. This is vital for it to heal properly.