Limb-sparing surgery for soft tissue sarcomas
People who have a soft tissue sarcoma can sometimes have limb-sparing surgery. This is when just the area of cancer, and some of the tissue around it, is removed. This avoids the need for amputation.
Before your operation, your doctor and the nurses on the ward will discuss your treatment with you in detail. It often helps to talk to someone who has had the same operation. The medical staff should be able to arrange this for you. On some wards, a clinical nurse specialist may be available to discuss any worries that you have.
If you’ve had chemotherapy, your body will need time to recover before limb-sparing surgery. Usually it takes at least a couple of weeks after chemotherapy before you are ready to have your operation.
Your doctor and anaesthetist will see you before the operation to make sure you understand what is going to happen and answer any questions you have. You will have to sign a consent form agreeing to the surgery - this, too, is a good time to ask any questions. Many people find that the more they know about what is going to happen, the less frightening it seems.
If you have body hair in the area that will be operated on, you will need to be shaved before your operation. This is done to reduce the risk of infection. You may be shaved in the operating theatre after you’ve had your anaesthetic (when you’re asleep).
At first, your limb will be firmly bandaged. This is to give the area time to heal. You will probably have one or two drainage tubes in the wound to remove any fluid that collects in the area of the operation. They will be removed once the fluid has stopped draining, usually after a few days.
Swelling around the wound
Sometimes, fluid can build up around the wound, especially following surgery to a buttock or limb. The swelling should gradually reduce over a few weeks. Sometimes, a lot of fluid builds up around the wound - this is known as a seroma. It may need to be drained by a doctor or nurse.
Nutrition and fluids
You may have a drip (infusion) going into a vein in your arm. This will give you fluids and nutrients for 2-3 days until you are able to eat and drink properly again. The nurses on the ward will then take the drip out.
Pain can usually be controlled effectively with painkillers. You’ll need to take these for a few days after your operation. They may be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.
To start with, you will probably need a strong painkiller such as morphine. You may be given intravenous pain relief through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller. You may also have a handset with a button you can press if you feel sore. This is called patient controlled analgesia (PCA). It’s designed so that you can’t have too much painkiller (an overdose), so it’s okay to press it whenever you’re uncomfortable.
If you’ve had surgery to your leg, you may have pain relief using an epidural. This is a fine tube that’s inserted through your back into the area just outside the membranes around your spinal cord, which is called the epidural space. A local anaesthetic can be continuously given into this space to numb the nerves that run to your legs.
Let your nurses and doctors know as soon as possible if you’re in pain. This will help them give you the combination and dose of painkillers that’s right for you.
Your nurses or the physiotherapist will teach you breathing and leg exercises. You can help yourself get better by doing the exercises as often as you need to. Breathing exercises will help to prevent you from getting a chest infection. Leg exercises will help stop clots forming in your legs. Chest infections or blood clots can develop if you’re not moving around as much as you normally would be.
Your nurses will encourage you to get up and about as soon as possible. However, limb-sparing surgery is a major operation, and you may have to stay in bed for some time afterwards. This may range from a couple of days to up to a week.
A physiotherapist will show you exercises to keep the muscles in the limb strong and supple. This is so you can use it normally once it’s strong enough. The physiotherapist will also help you move the limb once you’re up and about again. Sometimes, you will need a brace or support for your limb. If the operation was on your leg, you may be given crutches to use at first, while you’re learning to walk again. You will probably be left with a slight limp.
Sometimes, walking with a limp can put pressure on the leg and cause pain elsewhere in the body. Although it’s important to have any continuing pain checked by your doctor, it doesn’t necessarily mean that the cancer has come back.
Most people are able to go home once their wound has healed, usually about 7-10 days after their operation.
After limb-sparing surgery, radiotherapy treatment is usually given to the area of the operation to destroy any cancer cells that may still be in the area. This is done because it’s very difficult to be completely certain that all the cancer cells were removed during the operation.