Soft tissue sarcomas are cancerous tumors that form in the cells that make up the body's connective tissues. There are various types of sarcomas that can arise in different parts of the body such as the arm, leg, trunk, abdomen, and retroperitoneum (the region of the body at the very back of the abdomen and pelvis).
Surgery is a common treatment for this type of cancer. At Yale Medicine, surgeons work closely with radiation oncologists and medical oncologists to tailor treatment plans for each case. The research done at Yale Cancer Center—one of only 47 National Cancer Institute-designated comprehensive cancer centers in the United States and the only one in Connecticut—has dramatically improved the treatment for sarcoma.
What are the different kinds of soft tissue sarcoma?
Some of the more common types of sarcoma include:
- Liposarcomas, which form in fat tissue.
- Leiomyosarcomas, which arise from smooth muscle cells.
- Gastrointestinal stromal tumors, which often form in the stomach or small intestine.
Sarcomas can also arise from cartilage, nerves, fibrous tissue, blood vessels, and other connective tissue throughout the body.
Who is a candidate for soft tissue sarcoma surgery?
The size and location of the sarcoma and how aggressively it is growing will determine the extent of a patient’s surgery and the length of the hospital stay.
Sarcomas that form in the abdomen require more extensive operations than those that form in the arm or leg, because they may be be close to or intertwined with internal organs.
For instance, sarcomas that form in the abdomen or retroperitoneum often require more extensive operations because this type of surgery requires entry into the abdominal cavity and dissection and potentially removal of internal organs that are involved.
If tests show that a sarcoma has spread to other parts of the body, such as the lungs or the liver, the treatment plan may involve additional surgery to remove those cancers.
Large sarcomas in the arms, legs or trunk may also require extensive surgery depending on location, proximity to major nerves, vessels, bone, joints, and muscle groups, and the extent of reconstruction needed.
If the secondary cancer is in areas that cannot be removed, doctors may choose not to perform surgery.
Are there other treatments that accompany the surgery?
Before surgery, doctors may recommend several weeks of radiation in select patients depending on the type of sarcoma.
The purpose of using radiation before surgery is to potentially shrink the tumor and make it easier to operate on and to better ensure that cancer cells are not left behind.
At Yale Medicine, surgeons work closely with radiation oncologists and medical oncologists to tailor treatment plans for each patient.
“We tend to favor these combination therapies, which optimize outcomes for our patients,” says Dale Han, MD, a Yale Medicine cancer surgeon.
How is soft tissue sarcoma surgery performed?
Soft tissue sarcoma surgery is performed under general anesthesia and involves a skin incision and dissection of the tumor from the surrounding tissues.
The surgeon’s goal is to remove the entire tumor and a margin (1-2 centimeters) of tissue around it. This is done to reduce the risk of leaving cancer cells behind.
If a tumor in the arm or leg involves muscle, nerves, blood vessels or bones, surgeons may have to remove some of these tissues with the tumor. Many of these structures can be repaired or reconstructed to reduce any loss of function.
Removing a tumor in the abdomen or retroperitoneum sometimes requires removal of organs invaded by the tumor such as a kidney or parts of the bowel or urinary tract.
“In these cases, surgery can be longer and more complicated,” says Dr. Han, “but patients generally do well even if other structures need to be removed with the tumor.”
How does surgery for soft tissue sarcoma improve outcomes?
Surgery for soft-tissue sarcoma is much more advanced than it used to be. In many cases, doctors can remove the tumor, reduce the risk of the cancer coming back at the original site and minimize the risk for losing function in a limb or suffering long-term side effects.
“Many decades ago, sarcomas in the arm or the leg were often treated with amputation,” says Dr. Han.
Surgical techniques have advanced significantly.
“In many cases now, we specifically remove the tumor and a margin of tissue around the tumor which is usually much less extensive,” says Dr. Han. "This allows for better function and often sparing of uninvolved nearby tissues and organs."
Outcomes for soft tissue sarcoma surgery have also improved thanks in part to the use of radiation therapy and systemic therapy such as chemotherapy.
Today, the five-year survival rate for sarcoma patients overall is about 65-70 percent and is over 80 percent for patients with local disease.
What makes Yale Medicine’s approach to soft tissue sarcoma surgery unique?
Today, Yale Medicine patients have access to cutting-edge technology, experienced doctors and ongoing clinical trials that could lead to newer, better treatment options.
Because soft tissue sarcoma is often treated with a combination of surgery, radiation and systemic therapy, physicians from different departments work closely with each other to ensure the best outcome and experience for the patient.
“Doctors need to be able to tailor these therapies to the specific person and know which combination to use to provide the best outcome and experience for a particular patient,” says Dr Han. “And we do an extremely good job with that.”