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Surgery is commonly used to treat soft tissue sarcomas. Depending on the site and size of a sarcoma, surgery might be able to remove the cancer.

Surgery margins

The goal of surgery is to remove the entire tumor along with at least 1 to 2 cm (less than an inch) of the normal tissue around it. This is to make sure that no cancer cells are left behind.

After it’s removed, the doctor will check to see if cancer is growing in the margins (edges) of the specimen.

Positive margins are when cancer cells are found at the edges of the removed tissue. This means that cancer cells might have been left behind. When cancer cells are left after surgery, more treatment, such as radiation or another surgery, might be needed.

Negative or clear margins are when cancer isn’t growing into the edges of the tissue that’s removed. In this case, the sarcoma has much less chance of coming back after surgery and surgery might be the only treatment needed.

When the tumor is in the abdomen, it can be hard to remove it along with enough normal tissue to get clear margins because the tumor could be next to vital organs that can’t be taken out.

Amputation and limb-sparing surgery

In the past, many sarcomas in the arms and legs were treated by amputation (removing the limb). Today, this is rarely needed.

Instead, the standard is surgery to remove the tumor without amputation. This is called limb-sparing surgery. A tissue graft or an implant might be used to replace the removed tissue. This might be followed by radiation therapy.

Sometimes, an amputation can’t be avoided. It might be the only way to remove all the cancer. Other times, key nerves, muscles, bones, and blood vessels would have to be removed along with the cancer. If removing this tissue would mean leaving a limb that doesn't work well or would result in chronic pain, amputation might be the best option.

Surgery for sarcoma has spread

If the sarcoma has spread to distant sites such as the lungs or other organs, surgery might not be possible. If surgery is done, the goal is to remove the original tumor plus the areas of spread. If this isn't possible, then surgery might not be done at all.

Most of the time, surgery alone cannot cure a sarcoma once it has spread. But if it has only spread to a few spots in the lung, the metastatic tumors can sometimes be removed. This can cure patients or at least lead to long-term survival.

Lymph node dissection

If lymph nodes near the tumor are enlarged, cancer might be in them. During surgery, some of the swollen nodes might be sent to the lab and checked for cancer.

If cancer is found, the lymph nodes in the area will be removed. Radiation might be used in that area after surgery.

Treatments used with surgery

Neoadjuvant treatment is when another treatment, such as chemotherapy (chemo), radiation, or both, is given before surgery. It can be used to shrink the tumor so that it can be removed completely. Chemo or radiation can also be given before surgery to treat high-grade sarcomas that have a high risk of spreading.

Adjuvant treatment is when treatment such as chemo and/or radiation is used after surgery. The goal is to kill any cancer cells that might be left in the body to lower the risk of the cancer coming back.