Sarcomas are uncommon cancers that develop in the bones, muscles, joints, cartilage, nerves, and other connective tissues of the body. While rare overall, comprising about 1% of cancer cases, sarcomas require specialized expertise. Surgery is typically the mainstay of sarcoma treatment, often combined with radiation or chemotherapy. Understanding surgical options for these complex cancers is key.
Goals of Sarcoma Surgery
The primary objectives of sarcoma surgery are to:
- Completely remove the tumor and surrounding normal tissue margins
- Avoid cutting through tumor tissue to limit spread
- Confirm the sarcoma subtype from removed tissue
- Preserve limb function when possible
Limb-Sparing Surgery
Whereas amputation was once standard for sarcomas of the arms or legs, today limb-sparing surgery is often feasible. Advances in imaging, surgical tools, and techniques facilitate tumor removal while maintaining limb function. Radiation or chemotherapy before surgery can shrink tumors to aid resection.
However, major nerves or muscles may still need to be sacrificed. And in some cases, amputation remains the best option for complete tumor removal. Some patients may also choose amputation to avoid more complex surgery or prolonged recovery.
Surgery for Specific Sarcoma Types and Sites
For bone sarcomas like osteosarcoma, resection involves taking the tumor segment of bone and replacing it with a prosthesis, bone from elsewhere in the body, or donor bone. Joint involvement may require prosthetic replacement.
For retroperitoneal sarcomas, tumor removal may necessitate taking adjoining organs like the kidney. Abdominal sarcomas often require multi-organ resection and complex reconstruction. Spine tumors are challenging given the critical surrounding neurology. And skull sarcomas risk impacting brain structures.
The soft tissue sarcomas of the limbs, muscles, fat, fascia, and skin around the tumor are excised en bloc along with major vessels that are then repaired or grafted. For head and neck sarcomas, delicate dissection aims to preserve nerves and vessels.
Special Considerations for Sarcoma Surgery
Several factors guide surgery details:
Tumor Grade
Higher grade sarcomas tend to be more aggressive, requiring wider margins. Narrower margins may suffice for low grade tumors.
Tumor Size and Depth
Larger and deeper sarcomas need more extensive surgery. Small superficial low grade tumors can sometimes just undergo local excision.
Location
In some cases, critical structures surrounding sarcomas limit how much tissue can be removed.
Metastatic Disease
For limited lung metastases, metastasectomy may be considered when sarcoma is controlled elsewhere.
Patient Factors
Issues like age and comorbidities help determine if limb salvage or amputation better preserves function.
The Importance of a Multidisciplinary Sarcoma Team
Due to intricacies of sarcoma surgery, it is urged to find expert care. Surgeons experienced in sarcoma techniques work closely with medical and radiation oncologists, pathologists, physical therapists, and other specialists to optimize treatment. Ongoing advances provide new hope for restoring quality of life in sarcoma patients.
Reach out to orthopedic oncology specialist Dr. Herrick J. Siegel at Siegel Orthopaedics in Birmingham, AL to discuss whether complex sarcoma surgery is appropriate for your specific cancer situation. Dr. Siegel has the expertise to help guide decision-making on limb-preservation approaches versus amputation if sarcoma necessitates extensive resection.