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 surrounding tissue, is removed. This avoids the need for amputation (removal of the whole limb).

Before surgery, your doctor will talk with you about the operation. You can ask any questions about how the surgery might affect you. It’s fine to ask anything that helps you understand what to expect.

After the surgery, your limb will be firmly bandaged to give the area time to heal. Sometimes, fluid can build up around the wound. The swelling should gradually reduce over a few weeks. Most people are able to go home once their wound has healed.

Your nurses or physiotherapist will encourage you to walk around as soon as possible. This is to prevent you from getting problems such as clots in your legs.

If you have any pain after the surgery, let your doctor or nurse know. They can give you painkillers to control this.

Some people may have radiotherapy before or after limb-sparing surgery. Your doctor will discuss this with you.

Limb-sparing surgery

Before surgery, your doctor will explain the procedure to you to make sure you fully understand what is involved. You can ask questions about how the surgery might affect you.

You may find it helpful to talk to someone who has had the same operation. The medical staff or your keyworker may be able to arrange this for you. Some hospitals have a counsellor you can talk to about your feelings and any worries you may have before the operation.

For bone sarcomas some people like to see the replacement part or endoprosthesis (often just called a prosthesis) that will be used during their operation. If you would like to see it, your surgeon or keyworker can usually arrange it for you.

A physiotherapist may talk to you before your operation. They may give you some exercises to do before surgery to help strengthen your muscles.

If you have had neoadjuvant chemotherapy, it usually takes a couple of weeks before your blood cell levels get back to normal and you are ready to have your operation.


After your operation

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

Pain can usually be controlled effectively with painkillers. You’ll need to take them 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 is designed so that you can’t have too much painkiller (an overdose), so it is okay to press it whenever you are uncomfortable.

If you have had surgery to your leg, you may have pain relief using an epidural. This is a fine tube 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 are in pain. This will help them give you the combination and dose of painkillers that’s right for you.

They told me that things were good and that they had got rid of everything. A bit afterwards I got scared because I had the same strange pain, but that was caused by the wound post-surgery, so I was okay.

Hayley


Exercises

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 are not moving around as much as you normally would be.

Your nurses and physiotherapist will encourage you to get up and about as soon as possible.

A physiotherapist will usually show you exercises to keep the muscles in the limb strong and supple. This is so you can use it normally once it is strong enough. The physiotherapist will also usually help you move the limb once you are 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 are learning to walk again.

Sometimes, walking with a limp can put pressure on the leg and cause pain elsewhere in the body. Although it is important to have any continuing pain checked by your doctor, it doesn’t necessarily mean that the cancer has come back.


Going home

Most people are able to go home once their wound has healed.


Radiotherapy

Radiotherapy may be given before or after limb-sparing surgery. Before surgery, radiotherapy treatment is usually given to the area of the tumour and the surrounding area to try and shrink the tumour. After the operation, radiotherapy treatment is usually given 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. Your doctor will discuss the best options with you.

Back to Surgery explained

Amputation

Sometimes the affected limb needs to be removed (amputated). You will be offered counselling and support before and after surgery.

What happens after surgery?

You’ll be monitored very closely after your operation. You will be very tired so it’s important to rest and look after yourself.

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

Skin grafts and flaps

If a large area of skin is removed during surgery for a sarcoma, you may need a skin graft or flap.