Surgery is the primary treatment for most primary soft tissue sarcomas . This specialized treatment. Assuta Hospital offers the possibility of surgery, surgeons who are trained, have a great experience.
The main objective of surgery - to remove the tumor completely. The most common surgery to remove a sarcoma is a wide local excision. This means the removal of the tumor with a part of the healthy tissue around it. Resected tissue is then examined under a microscope. Negative surgical margin means that the malignant cells have not been identified on it.
Type of operation will depend on the location sarcoma. A large proportion of tumors occurs in the region of the limbs. However, they can occur in any part of the body. For example, leiomyosarcoma is in the womb.
Sometimes surgery - this is the only necessary treatment when:
- Sarcoma - low-grade;
- tumor - the surface does not reach deep tissues - muscles;
- with positive surgical edge, if necessary re-resection, during which will remove more tissue. If an operation to remove a sarcoma is not possible, refer to the exposure.
When the tumor develops in inaccessible places, for example, in the abdominal cavity close to vital organs, which can not be removed or they may be damaged during the operation, other methods are used. This exposure may be with or without cytotoxic drugs.
Retroperitoneal space - an area at the back of the abdominal cavity. When the diagnosis is often retroperitoneal sarcoma is fairly large -. An average of 15-20 cm or 6-8 cm in 50-70% of cases the tumor grows into the next process arranged structure. As a result, it may require removal of the following organs - colon, kidney, small intestine, bladder, major blood vessels to eliminate the pathological process of an organism.
Benefits in the treatment of Kaposi Medical Center Assuta :
- The team of doctors who specialize in the treatment of this disease.
- Recent diagnostic tools and modern equipment.
- Advanced surgical procedures, including organ-preserving surgery for sarcoma.
- The newest chemotherapy .
- Genetic testing.
- Clinical trials of new methods for the treatment of sarcoma.
Before the operation for removing sarcoma in Assuta
A surgeon who specializes in the treatment of sarcomas, will be part of a multidisciplinary team of doctors working with patients. He will make a thorough assessment and will follow the standard surgical procedure.
Before removal of the tumor on the arm or leg is studied skin condition, especially if carried out before exposure. Skin that has received radiation therapy, can not fully recover after surgery sarcoma. The surgeon will find out if special procedures are required, such as skin grafts to cover the area after surgery.
To evaluate requires a biopsy. Often, it performs a surgeon who specializes in soft tissue sarcoma. He plans to biopsy and surgery together, since the area where the sample is taken, is often removed during surgery. biopsy planning and operation ensures minimum damage to healthy tissue and the best functional results.
Types of operations in Kaposi
Type of surgery is determined based on the type of sarcoma, its location and size.
Wide local excision
During this surgery the surgeon removes malignant tumor and a margin of healthy tissue. The amount of tissue removed is determined on the basis of localization and stage tumors, sarcomas type previously conducted irradiation. In some areas difficult to resect a wide margin, for example, on the head or neck due to the risk of damaging important structures. Depending on the size of the resected tissue is used plastic surgery - skin grafts or flaps.
Gentle or conserving surgery
If sarcoma located on the arm or leg, the surgeon can remove the tumor, and partially surrounding tissue. Sparing surgery is usually applied when the neoplastic process has not affected the major blood vessels or nerves.
Conserving surgery with sarcoma - a complicated procedure in which the tumor is removed, but not the arm or leg. The surgeon tries to save located near the tendons, nerves and blood vessels to keep the maximum number of functions. The doctor leaves a sufficient volume of soft tissues, skin and muscles for recovery or reconstruction of a functional limb.
Depending on the magnitude of the removed tissue the surgeon may replace it with a graft or graft tissue to be borrowed from the other body part. Many patients require the use of plastics technology patchwork consisting of skin transplantation, subcutaneous tissue and muscle tissue.
The patient will stay in hospital for 7 to 10 days. If low-grade sarcoma, probably after the human body to recover, will be assigned to radiotherapy. It reduces the risk of the return of the disease in this area.
If there is a relapse, conducted another operation to remove a sarcoma, in which more than resected tissue may be needed in the future amputation.
Sometimes the only way of getting rid of sarcoma is the removal of a limb or limb part, wherein the tumor develops. Today in Israel, amputation is performed in less than 5% of cases.
Ablation may be the only option if the tumor is large and spread to major blood vessels, nerves or muscles. Their removal will provide a non-functional limb or long-term problems. In some cases, amputation is necessary because sarcomas recurred in the same limb-sparing surgery after previous.
Using imaging techniques such as MRI, the surgeon determines the size of amputation. Muscles, soft tissues, the skin is used to form a cuff around the bone.
In cases where there are secondary lesions, which together with the primary tumor can not be surgically removed, amputation will not be held.
If recommended amputation, the patient runs a special multidisciplinary team of physicians, nurses, physiotherapists, prosthetists. Assisted before surgery to remove a sarcoma, as well as in the process of recovery and rehabilitation.
Psychological support is extremely important, it fully exert Assuta psychologists.
During some operations, sarcoma of soft tissue the surgeon has to remove a sufficiently large amount of fabric. Accordingly, you may need plastic surgery to rebuild the region. It is carried out at the same time as the basic operations for sarcoma. The choice of a specific surgical procedure will depend on where the body is and how much tissue sarcoma surgeon must remove.
Whatever the type of plastic surgery, the surgeon's main task - to achieve the result, returning the most natural look.
If the surgery is relatively small, the surgeon simply pulls the fabric together and stitch. But sometimes the healthy tissue is not enough, so the doctor has to take a flap of skin from another place. The area has been removed from the skin, usually heals within several weeks after surgery. Healing the reduced space usually takes longer.
To restore large areas of applied plastic flap. Various types of plastics, depending on the area of the wound size and sarcomas. Local flap means that the surgeon uses tissue near the wound to repair it. The flap on the leg taken from more remote areas, but close enough to keep a natural blood supply.
Subcutaneous tissue taken from the same section as the skin. A flap of skin and tissue is removed along with blood vessels. The surgeon connects the vessels in the reduction zone, creating a good blood supply.
In most cases, sarcoma does not penetrate into the bone, so the bone removal is required. If all this happens, the remote segment may be replaced by a bone graft, or an internal prosthesis (endoprosthesis) made of metal or other materials. Implantation is made into a healthy part of the bone. surgery may be required in the future, if the graft or prosthesis to weaken or break.
Surgery of lung metastases
Operation sarcoma, aimed at removing secondary foci in the lungs, performed in the following cases:
- The primary tumor is controlled.
- Number of metastases to 3.
- High probability that the tumor in the lung will be completely removed, restored organ functionality.
- The patient is healthy enough to undergo surgery.
Choosing the type of surgical intervention is determined based on the size and location of a metastasis in the lungs, as well as the surgeon's preference.
After the operation in Kaposi in Assuta
This type of surgery can be very challenging. Choosing the type of surgery and recovery process depends on the location and type of sarcoma. The doctor at the clinic Assuta describe in detail what to expect after surgery.
To a patient after surgery to remove some sarcomas attached devices. The liquid and blood accumulates in the region where the tumor was resected. In this zone are installed drains to remove fluid and blood. Drainage tubes reduce the risk of infection. The probability of infection - a common problem with limb-sparing surgery, especially if preoperative irradiation was performed.
Some patients tolerate extensive surgery for soft tissue sarcomas. In such cases it is necessary to stay in bed for the first few days. Wake up after surgery may cause significant difficulties. If the tumor is removed from the arm or leg, the limb will need to be treated before the patient will be able to fully enjoy it.
If the amputation was carried out, it will need a prosthesis. Held a meeting with the prosthetist before and after surgery. The specialist will talk about appropriate types of prostheses.
Possible side effects of surgery in Kaposi
Different patients may develop various complications, some people see a large number of side effects, while others - no.
Factors that influence the occurrence of unwanted complications are:
- Type sarcoma.
- General state of health.
- The effects of other cancer treatments performed prior to surgery. For example, radiation therapy affects the healing process after surgery.
It is important to notify the team of doctors, which interacts with the patient about any side effects. The sooner they know about the problem, the more will be offered ways to help cope with them faster.
- The pain caused by tissue damage. The clinic Assuta apply effective analgesics control pain. In some patients after amputation phantom pain occurs, which is caused by damaged nerves during surgery. It includes burning, itching, cramping, pulsation. Typically, this pain occurs in the first month and takes place in the first year.
- Some patients may develop a wound infection. To prevent and treat infection used antibiotics.
- Due to accumulation of fluid in the incision site may appear edema. To remove it use drains.
- The edges of the wound are joined by stitches or staples. After surgery to remove a sarcoma sometimes dehiscence occurs. If the divergence concerns the edges of the skin, this is not a serious problem, but if it is - fat and muscle tissue, is sufficiently serious. This condition can lead to a hernia, when the organs or tissues protrude through the abdominal wall. Within 8 weeks or more to avoid strenuous physical activity to prevent wound dehiscence.
- Radiation therapy prior to surgery in Kaposi may impair healing and recovery process also increase the likelihood of other complications, such as infection. Impair the healing of diabetes, atherosclerosis, smoking, and other factors.
- Immediately after the operation due to the lack of movement may develop deep vein thrombosis. Special exercises for the legs with bed rest can help reduce the risk of this complication.
- Surgery can cause stiffness or weakness in the limbs - arm, shoulder, leg or thigh. It is also possible limitation of motion after surgery.
- Nerves can become damaged or removed during surgery. This results in numbness, tingling limbs, or changes in sensation. Nerve damage is manifested soon after surgery can last a long time.
- Surgery for Kaposi changes appearance of the body, affects the self-esteem. Removal of a large amount of tissue is obvious changes. For example, amputation and prosthesis may be required for limb sarcomas. Sarcoma of the chest can cause a mastectomy, in the abdominal cavity - the creation of a colostomy.
- Removal of a large amount of tissue leads to the formation of scars. Redness of the scar disappears soon after the surgery.