Surgery for Soft Tissue Sarcoma
At NYU Langone, surgery for soft tissue sarcoma involves removing the growth, along with some surrounding healthy tissue, to ensure that the cancer is gone. If a large tumor is close to vital organs, complete removal may not be possible.
As a result, our doctors may recommend chemotherapy before surgery to shrink the tumor, and after surgery to help destroy remaining cancer cells. This effective approach was pioneered by sarcoma doctors at NYU Langone.
Radiation therapy, the use of high levels of energy to kill cancer cells, may also be used before surgery, along with chemotherapy. Factors such as the tumor type, its size, and its characteristics under the microscope help doctors determine the treatment plan before and after surgery.
For some types of soft tissue sarcomas, surgically removing the tumor with a clear margin of healthy tissue may be the only treatment you need. Sarcomas are uncommon cancers that often require complex surgery. The surgical approach often depends on the tumor’s location.
A team of surgical experts and other specialists at NYU Langone aid in managing these tumors. For example, if the tumor wraps around important blood vessels and nerves, vascular surgeons and neurosurgeons may join your cancer care team.
Surgery for Sarcoma of the Limbs
Some types of soft tissue sarcomas may form in the arms or legs, including liposarcoma, fibrosarcoma, and synovial sarcomas, among others. When a soft tissue sarcoma is found in an arm or a leg, our doctors make every effort to perform limb-sparing surgery—removing the tumor while leaving the rest of the affected limb intact and functional.
Limb Sparing Surgery
A group of surgical oncologists and orthopedic oncologists at NYU Langone specializes in surgery for people with soft tissue sarcoma. For people with tumors in the arms and legs, this means limb sparing surgery is often an option.
For soft tissue sarcomas, a reconstructive surgeon may use a flap, or a portion of muscle and tissue from nearby or from another part of the body, such as the abdomen or back, to cover and repair places where the cancer was removed.
Sometimes, surgeons may move this flap of tissue without cutting its original blood supply. Other times, they may cut the blood vessels, along with the tissue flap, and carefully reattach these vessels at the site where the tumor had been.
Surgeons can also make this flap functional in its new location by attaching it to existing nerves in the arm or leg or by using grafts, which are portions of unrelated nerves removed from another part of the body.
If your surgeon removes part of a bone during surgery because the sarcoma has spread, he or she may replace it with a prosthesis, a device made of metal and plastic, or with bone from a cadaver.
After limb sparing surgery, doctors at NYU Langone’s Rusk Rehabilitation often prescribe a program of physical and occupational therapy to help restore function to the arm or leg, so that you can return as soon as possible to your usual activities.
Very rarely, if a cancer is large or wraps around important blood vessels, nerves, or other structures and cannot be removed with limb sparing approaches, the surgical team may need to remove an arm or a leg.
Afterward, you have the option of being fitted with a prosthetic limb. Our Rusk Rehabilitation physicians can ensure you receive one that best matches your level of physical activity.
Our doctors at Rusk Rehabilitation can prescribe physical therapy, occupational therapy, and other rehabilitative techniques, as well as ongoing psychological support, to help you grow comfortable with the prosthetic as you return to your daily routine.
Surgery for Other Sarcoma Sites
Although rare, soft tissue sarcomas may occur in the head, the retroperitoneum (the area deep within the abdomen), the pelvic cavity, the uterus, the chest wall, or the gastrointestinal tract. These tumors are often managed with surgery but, as with other sarcomas, may also require radiation therapy or chemotherapy.
Head and Neck Sarcoma
Soft tissue sarcomas such as alveolar soft part sarcomas and dermatofibrosarcomas can develop in the head and neck and may be managed with surgery. Usually, our doctors recommend chemotherapy and radiation before surgery.
If the tumor invades the jawbone, surgeons may need to reconstruct the bone after removing the tumor. NYU Langone doctors may use bone tissue from the leg, and they are pioneers in planning the surgery using computer-generated, three-dimensional models.
Other bones in the face can also be reconstructed. For example, the cheekbones, eye sockets, or the palate (the roof of the mouth) can be replaced with bone from other parts of the body, such as the leg, forearm, or scapula (the shoulder blade).
Sarcomas may develop in the soft tissue of the retroperitoneum, an area deep within the abdomen. Because these don’t cause symptoms, they often go undetected until they are relatively large. Most retroperitoneal sarcomas are liposarcoma and leiomyosarcoma.
Sometimes, other organs, such as the pancreas, part or much of the stomach, the spleen, or a part of the intestines, may need to be removed if the cancer has spread. Most of the time, retroperitoneal sarcomas develop close to or grow into the kidney, making the removal of one kidney necessary to prevent the tumor from coming back. Removing one kidney is usually safe, and the remaining kidney takes over the job of filtering the blood and making urine.
Our doctors and rehabilitative experts can help you adjust to the changes that occur in the body after an organ or part of an organ is removed.
Pelvic Cavity Sarcomas
Soft tissue sarcomas may also develop in the pelvic area. These tumors tend to be large by the time they are detected. They may spread to the pelvic bone, making reconstructive surgery an important part of treatment.
Surgeons may use a bone from the leg to reconstruct the pelvis. Other options include using bones from a donor or a special cement to replace the bones in the pelvis.
Leiomyosarcomas may develop in a woman’s uterus, also known as the womb. To treat this tumor, surgeons may remove the uterus and the cervix, the narrow opening at the bottom of the uterus. They may also remove the upper portion of the vagina, the muscular canal that leads from the cervix to the outside of the body, and the connective tissue of the pelvis.
This surgery can also include the removal of nearby lymph nodes, small immune system glands located throughout the body. Our surgeons may also recommend removal of the ovaries, the small reproductive organs on either side of the uterus that contain a woman’s eggs, and the fallopian tubes, which carry the eggs from the ovaries to the uterus.
Chest Wall Sarcomas
The chest wall consists of muscle, tissue, and bones that protect the organs in the chest cavity. When a sarcoma develops in soft tissues of the chest wall, our thoracic surgeons, surgical oncologists, and reconstructive surgeons may work to remove the tumor and a margin of surrounding healthy tissue while protecting the area’s vital organs, including the lungs and heart.
Our doctors usually recommend chemotherapy and radiation therapy before surgery for chest wall sarcomas to reduce the chance that the cancer spreads or recurs.
Gastrointestinal stromal tumors can develop in the gastrointestinal tract, the group of organs involved in digesting food. Most of these sarcomas occur in the stomach or small intestines. Surgeons can manage these cancers by removing the tumor and the surrounding portion of the stomach or intestine. Sometimes, targeted medications can help to shrink these tumors before surgery.
Rehabilitation After Surgery
Your hospital stay and recovery after surgery for soft tissue sarcoma depend on the type of surgery you have and your overall health. If you undergo limb sparing surgery, amputation, or reconstruction, you may need a comprehensive rehabilitation program, including physical and occupational therapy and psychological support.
These services are available at Rusk Rehabilitation under the guidance of our rehabilitation doctors, who ensure you receive the follow-up care you need to regain your independence.
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