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Chapter 29. Operative Management of Soft Tissue Sarcoma

Dan G. Blazer III, MD; Alfred E. Chang, MD

  • Any soft tissue mass that is large or growing should be evaluated by biopsy using the techniques described later.
  • When the diagnosis of sarcoma is established, surgery remains the mainstay of therapy.

  • Medical comorbidities such as severe cardiopulmonary compromise may preclude safe surgery.

  • The patient may be placed supine, prone, or in lateral position depending on the location of the lesion.
  • If a soft tissue flap reconstruction is planned, communication with the plastic surgery team is essential when positioning the patient.

  • Patients are quickly advanced to a regular diet.
  • Activity restrictions vary and depend on the location of surgery and type of plastic surgical reconstruction, if any.

  • Common complications include surgical site infection, hematoma, seroma, and wound breakdown (especially in previously irradiated tissue).
  • Sarcomas may lie in proximity to major neurovascular structures that may be inadvertently damaged or taken purposefully en bloc with the specimen.
  • Other systemic complications of major surgery (pneumonia, venous thromboembolism, and cardiovascular events) can also occur.

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