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Surgery of soft tissue sarcoma of the abdomen and pelvis

Surgical resection with negative margins remains the standard treatment for patients with localized abdominal sarcomas, including retroperitoneal, intra-abdominal, abdominal wall and gynecological sarcomas.

The goal and requisite for cure is complete surgical resection with microscopic tumor-free margins in the first attempt. This procedure predisposes that the tumor is removed without contamination of surrounding tissue and the abdominal cavity from inadvertent dissection into the tumor pseudocapsule or overt tumor rupture.

The size of the tumor, pattern of growth, and location close to vital organs and structures at the time of diagnosis often renders the surgical resection a complicated procedure. Good preoperative planning is crucial. 

All radiological images must be assessed carefully to plan the extent of the surgery. As complete resection is the goal, adequate margins around the tumor must be defined. Compression of the tissue around the lesion versus direct tumor infiltration into structures is not always evident radiologically. When necessary, surrounding organs must be assessed for en bloc resection.

In retroperitoneal soft tissue sarcomas especially, en bloc resection of organs surrounding the tumor is often necessary in order to achieve the goal of a complete resection. This is performed in up to 80% of cases. This principle also applies to sarcomas in other abdominal and pelvic localizations.

 

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