Advances: Sarcoma Surgery

Advanced Surgery Techniques for Treatment of Soft Tissue Sarcoma

Advanced Surgery Techniques for Treatment of Soft Tissue Sarcoma

Soft tissue sarcomas are rare malignancies that usually arise from tissues of mesenchymal origin (e.g. fat, muscle, and connective tissue) and can occur throughout the body. There are only about 8,000 new cases of soft tissue sarcoma in the United States per year, and the most common sites include the extremity (arm and leg), trunk (chest and abdominal wall), abdomen (intra-abdominal and retroperitoneum), and head/neck. Soft tissue sarcomas are subclassifed into over 50 different histologic subtypes with the most common subtypes being liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, synovial sarcoma, and fibrosarcoma. These tumors are graded based on their appearance under the microscope as either low-grade tumors, (which tend to grow slowly and are unlikely to spread to distant sites), or high-grade tumors, which tend to grow more rapidly and have a higher risk of distant metastases).

Given soft tissue sarcomas are rare, occur in several sites, and have numerous subtypes, many physicians are unfamiliar with the appropriate diagnostic procedures and treatment of these tumors. Common diagnostic radiology tests include computed tomography (CT) scans and magnetic resonance imaging (MRI). Positive emission tomography (PET) scans and combined PET/CT scans are also used in certain circumstances to rule out spread of disease. Biopsies of suspected soft tissue sarcomas should be undertaken carefully so as to avoid the spread the tumor cells and to orient the biopsy scar/tract such that it is encompassed by the definitive operation. Besides surgery, additional treatment modalities may be necessary to optimally treat soft tissue sarcoma such as radiation therapy and chemotherapy. There are instances where the chemotherapy and radiation therapy may be better given prior to operation to obtain better local control and limit the extent of the operation.

Soft tissue sarcomas arising in difficult anatomic locations may require extensive surgical expertise to remove in their entirety with a negative surgical margin. Such anatomic locations include:

  1. extremity adjacent to major nerves, blood vessels, bones, and joints
  2. trunk requiring reconstruction of the abdominal wall or chest wall
  3. abdomen (intra-abdominal and retroperitoneum) adjacent to major organs, blood vessels, nerves, ureters, and bones

In addition to extensive surgical experience, advanced radiation therapy techniques and chemotherapy may be required to obtain optimal local control of certain sarcomas. The Cancer Center's Center for Sarcoma and Connective Tissue Oncology, has an entire team of clinical specialists to optimally care for sarcoma patients. This team includes surgeons from other subspecialties, radiologists, pathologists, and nurses who are familiar with the care of patients with soft tissue sarcoma. The team meets weekly to review new patients and formulate a treatment plan and also reviews follow-up patients to determine if additional treatment is needed.