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🦴 Sarcoma Surgery · Limb-Preservation Focus

Soft Tissue Sarcoma
Surgery & Limb-Preservation

Wide Local Excision. Function-Preserving Surgery. Multidisciplinary Care. — Expert management of soft tissue sarcomas at KG Hospital, Coimbatore, with a focus on clear surgical margins while preserving limb function wherever possible.

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Dr. Prabhakaran U - Surgical Oncologist and Sarcoma Surgeon at KG Hospital Coimbatore
Dr. Prabhakaran U
Surgical Oncologist &
Sarcoma Surgeon
KG Hospital · Coimbatore

Understanding Soft Tissue Sarcoma

What is Soft Tissue Sarcoma?

Soft tissue sarcomas are a rare group of cancers arising from connective tissues — muscle, fat, blood vessels, nerves, tendons, and the tissue surrounding joints. Unlike more common cancers, sarcomas can develop almost anywhere in the body, though they most often appear in the arms, legs, chest, or abdomen (retroperitoneum).

There are more than 70 subtypes of soft tissue sarcoma, each with different behaviour, growth rate, and treatment approach. Because they are uncommon and can mimic benign lumps, sarcomas are frequently misdiagnosed or delayed in diagnosis — making evaluation by an experienced surgical oncologist essential.

As a Surgical Oncologist managing the full range of soft tissue tumours, Dr. Prabhakaran U focuses on achieving complete surgical removal with clear margins, while preserving as much normal function as possible — avoiding amputation in the vast majority of extremity sarcoma cases.

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Surgical Oncology Training:
• MCh Surgical Oncology — Regional Cancer Centre (RCC), Trivandrum (2018–2021)
• Experience spanning 1,000+ cancer surgeries across multiple tumour types
• Advanced fellowships across India, China, Singapore, and Thailand

📊 Key Facts — Soft Tissue Sarcoma

  • Account for less than 1% of all adult cancers
  • Over 70 distinct subtypes exist
  • Most common sites: extremities (43%), trunk, and retroperitoneum
  • Low-grade, localised sarcoma: 5-year survival 80–90% with complete resection
  • Limb-sparing surgery achieves local control equivalent to amputation in over 90% of extremity cases
  • Diagnosis is frequently delayed as lumps are mistaken for benign cysts or lipomas

Common Types of Soft Tissue Sarcoma

  • Liposarcoma — arises from fat tissue; the most common soft tissue sarcoma in adults, often found in the limbs or retroperitoneum.
  • Leiomyosarcoma — arises from smooth muscle; can occur in the limbs, uterus, or blood vessels.
  • Synovial sarcoma — typically affects younger adults, often near joints of the arms or legs.
  • Gastrointestinal Stromal Tumour (GIST) — arises in the wall of the stomach or intestine; treated with surgery and, in many cases, targeted therapy.
  • Rhabdomyosarcoma — arises from skeletal muscle; more common in children and young adults.
  • Undifferentiated pleomorphic sarcoma (UPS) — an aggressive subtype most often seen in the limbs of older adults.

Recognising Sarcoma

Symptoms of Soft Tissue Sarcoma — Do Not Ignore These

Soft tissue sarcomas often grow silently and painlessly in the early stages, which is why they are so frequently mistaken for a harmless lump. Deep-seated tumours in the thigh or abdomen can reach a considerable size before causing noticeable symptoms — making prompt evaluation of any new or growing lump essential.

Common Symptoms — See a Doctor If You Have:

  • A lump or swelling larger than 5 cm (about the size of a golf ball)
  • A lump that is growing in size over weeks to months
  • A lump that feels firm and deep to the muscle, rather than soft and mobile under the skin
  • A previously stable lump that has recently started to enlarge or become painful
  • Abdominal fullness, discomfort, or a mass felt in the abdomen (retroperitoneal sarcoma)
  • Unexplained weight loss accompanying a growing mass
  • Numbness, tingling, or weakness if the tumour is pressing on a nearby nerve

⚠️ Do not wait: Any lump larger than 5 cm, deep to the muscle, or growing in size should be evaluated promptly with an MRI and, if indicated, a biopsy — regardless of whether it is painful. Most sarcomas are painless in their early stages.

Sarcoma Grading & Staging

Unlike many cancers, sarcoma treatment planning depends heavily on tumour grade (how aggressive the cells look) as well as size and depth, which together guide the staging:

Low-Grade

Slow-growing, less likely to spread — surgery alone is often curative

5-year survival: 80–90%

Intermediate-Grade

Moderate growth rate — surgery often combined with radiotherapy

5-year survival: 60–80%

High-Grade

Aggressive, higher risk of spread — multidisciplinary treatment needed

5-year survival: 40–60%

Metastatic

Spread to distant sites, most often the lungs

5-year survival: varies widely

Diagnosis — What Tests Are Needed?

  • MRI scan — the most important imaging test for extremity and trunk sarcomas
  • CT scan of the abdomen — preferred for retroperitoneal (abdominal) sarcomas
  • Core needle biopsy — obtains tissue for diagnosis; performed before definitive surgery in almost all cases
  • CT chest — to check for lung metastases, the most common site of spread
  • Histopathology & immunohistochemistry — confirms subtype and grade
  • Multidisciplinary tumour board review — before finalising the treatment plan

Surgical Treatment Options

Surgery for Soft Tissue Sarcoma — Expert Care at KG Hospital

Complete surgical removal with clear (negative) margins is the cornerstone of curative treatment for soft tissue sarcoma. Dr. Prabhakaran performs the full range of sarcoma surgery, with a consistent focus on preserving function:

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Wide Local Excision

Removal of the tumour along with a cuff of surrounding healthy tissue to achieve clear margins — the standard curative operation for most soft tissue sarcomas. Margin status is the single biggest factor determining long-term outcome.

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Limb-Salvage Surgery

Function-preserving removal of extremity sarcomas, often combined with reconstruction of muscle, vessels, or nerves. Now possible in the vast majority of limb sarcoma cases, sparing patients from amputation while maintaining oncological safety.

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Compartment Resection

Removal of an entire muscle compartment when a tumour has spread throughout it — reserved for select cases where this offers the best chance of clear margins while still preserving the limb.

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Retroperitoneal Sarcoma Surgery

Complex resection of sarcomas arising deep in the abdomen, often requiring removal of adjacent organs (kidney, colon, spleen) en bloc to achieve complete clearance. Performed with meticulous planning based on CT imaging.

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Pulmonary Metastasectomy

Surgical removal of sarcoma deposits that have spread to the lungs. Selected patients with limited, resectable lung metastases benefit from surgery — offering improved survival in carefully chosen cases.

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Amputation (Rare, Last Resort)

Reserved for the small minority of cases where a tumour cannot be safely removed with limb-preservation — for example, when major nerves or vessels are extensively involved. Every effort is made to avoid this wherever oncologically safe.

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Multidisciplinary Sarcoma Care — KG Hospital, Coimbatore
Every sarcoma case is planned in coordination with radiology, pathology, medical oncology, and radiation oncology to ensure the surgical plan gives the patient the best chance of cure and function.

Function-Preserving Surgery

Achieving Clear Margins While Preserving Function

The single most important predictor of local recurrence after sarcoma surgery is achieving a clear (negative) margin — meaning no tumour cells at the edge of the removed tissue. Because of this, Dr. Prabhakaran plans every sarcoma resection carefully around MRI or CT imaging before the first incision is made.

At the same time, modern sarcoma surgery is designed to preserve as much normal function as possible. This is achieved through careful pre-operative planning, nerve- and vessel-sparing dissection wherever oncologically safe, and close collaboration with plastic and reconstructive surgery teams when needed.

Reconstruction After Sarcoma Surgery

  • Soft tissue reconstruction — local or free flaps to cover large defects after wide excision
  • Vascular reconstruction — repair or grafting of blood vessels involved by the tumour
  • Nerve preservation or grafting — protecting limb function wherever the tumour margin allows
  • Skin grafting — for closure of large superficial defects

Non-Surgical Treatments for Sarcoma

Surgery alone is not always enough. Depending on tumour size, grade, and location, other treatments are used — often in combination with surgery:

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Radiotherapy

Used before or after surgery for high-grade or large tumours, to reduce the risk of local recurrence — particularly important in limb-preservation surgery.

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Chemotherapy

Used for certain aggressive subtypes (e.g. rhabdomyosarcoma, synovial sarcoma) or in the metastatic setting to control disease spread.

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Targeted Therapy

Drugs such as imatinib for GIST specifically target the molecular drivers of certain sarcoma subtypes, often with excellent results.

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Surveillance

Regular follow-up with clinical exam and imaging after treatment, since sarcomas can recur locally or spread to the lungs even after successful surgery.

Multidisciplinary approach: All sarcoma cases are discussed at a tumour board involving oncologists, radiologists, and pathologists before a surgical plan is finalised. Treatment decisions are never made by the surgeon alone.

Common Questions

Frequently Asked Questions

What are the signs of a soft tissue sarcoma?
A rapidly growing lump — especially larger than 5 cm, deep to the muscle, or growing — should be evaluated promptly with MRI and possible biopsy. Most sarcomas are painless in the early stages, which is why they are often mistaken for a harmless lump or lipoma.
Will I need amputation for sarcoma?
In most cases, no. Modern limb-sparing surgery combined with radiotherapy achieves equivalent local control to amputation in over 90% of extremity sarcoma patients, with far better functional outcomes. Amputation is reserved for the small minority of cases where major nerves or vessels are extensively involved.
Can soft tissue sarcoma be cured with surgery?
Yes — particularly for low-grade, localised sarcomas, where complete surgical removal with clear margins offers a 5-year survival rate of 80–90%. Higher-grade or larger tumours are usually treated with surgery combined with radiotherapy or chemotherapy for the best outcome.
Is a biopsy always needed before sarcoma surgery?
Yes, in almost all cases. A core needle biopsy confirms the diagnosis and subtype before definitive surgery, since the surgical plan — the extent of excision, whether radiotherapy is needed beforehand — depends on knowing exactly what type and grade of sarcoma is being treated.
Where does soft tissue sarcoma commonly spread?
The lungs are by far the most common site of spread for soft tissue sarcoma. This is why a CT chest is part of routine staging, and why long-term surveillance after treatment includes periodic chest imaging. Selected patients with limited lung metastases may still benefit from surgical removal (metastasectomy).
Is retroperitoneal (abdominal) sarcoma surgery available in Coimbatore?
Yes. Dr. Prabhakaran U performs complex retroperitoneal sarcoma resections at KG Hospital, Coimbatore, including en bloc removal of adjacent organs when required for complete clearance. Call +91 90826 99710 to arrange a consultation and bring your MRI or CT reports.

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Consult Dr. Prabhakaran — Sarcoma Surgeon

Surgical Oncologist · Limb-Preservation Focus
KG Hospital, Coimbatore

📞 Call +91 90826 99710 ✉️ Email for Appointment