Sarcoma Surgery

What Are Sarcomas?

These are rare malignant tumors arising from connective tissue, such as fat, muscle, bone, nerves, blood vessels, encompassing more than 50 histiotypes. About 60% arise in the extremities (lower > upper), 20% trunk, and 20% retroperitoneum, head and neck. The overall 5 year survival is 50 to 60%. Deaths are usually from metastatic disease within 2-to 3 years of diagnosis. The most common cell types include: malignant fibrous histiocytoma, leiomyosarcoma, and liposarcomas.

Sarcoma Surgery

The majority involves the extremities and thankfully, an amputation can be avoided 90% of the time. Ideally, the surgeon will strive for a 2cm gross margin, taking periosteum from the bone, but rarely needing to resect bone. Lymph node resection is usually unnecessary. Drains are typically left in. A low threshold for postoperative radiation should be employed, especially high grade (aggressive), large tumors (>5cm), or close margins on nerves, blood vessels, or bone. The mortality is under 1%, and most complications involve wound healing, or the collection of fluid in the wound bed (seroma).

Retroperitoneal sarcomas grow deep within the abdomen and obtain large sizes before diagnosis. These are commonly removed through midline incisions, most often needing to remove additional organs (kidney, small bowel, colon, pancreas, stomach, or spleen). The complication rate is dictated by the organ that is removed. The local recurrence rate (chance of tumor coming back in the abdomen) approaches 70%.

PreOp Evaluation/Preparation

  • Some form of biopsy, core needle biopsy if possible.
  • CT scan of chest, abdomen, and the affected body part.
  • Sometimes, MRI provides additional information of the extremity.
  • For retroperitoneal sarcomas, patients will be admitted the day before surgery for bowel prep.
  • You will be on clear liquids the day before your surgery. Do not eat and drink within 6 hours of surgery.
  • If you have had prior Staph infections, please let your surgeon know. A cardiac or pulmonary evaluation may necessary.

Post-Op Care

  • For extremity sarcomas, patients will typically have drains. If you have drains, make sure you know how to empty these and record the output.
  • The incisions themselves need no special care. The drain site can be covered with a Band-aid and antibiotic ointment.
  • Call the office about 4-5 days after your surgery to set up a 2 week follow up appointment and to get a preliminary report on your pathology. Physical therapy will be started in the hospital and continued once discharged.
  • For retroperitoneal sarcomas, recovery is similar to other major abdominal surgery.
  • You can shower, walking is encouraged, no lifting more than 10 pounds for 6 weeks, no driving for about 4 weeks.

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