21936 Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; 5 cm or greater

Name of the Procedure:

Radical Resection of Tumor (eg, Sarcoma), Soft Tissue of Back or Flank; 5 cm or Greater

Summary

Radical resection of a tumor in soft tissue of the back or flank involves surgically removing a large mass (5 cm or greater) along with some surrounding healthy tissue to ensure complete excision. This procedure is typically used to treat malignant tumors like sarcomas.

Purpose

This procedure aims to remove malignant tumors from the soft tissues in the back or flank. The goal is to ensure clear margins, which means taking out some surrounding healthy tissue along with the tumor, to minimize the chances of recurrence and spread.

Indications

• Presence of a soft tissue sarcoma or other malignant tumors in the back or flank region.
• Tumor size of 5 cm or greater.
• Diagnostic imaging or biopsy indicating malignancy.
• Symptoms such as pain, swelling, or functional impairment due to the tumor's size or location.

Preparation

• Patients may need to fast for at least 8 hours before the procedure.
• It's crucial to discuss current medications with the surgeon; some may need to be adjusted.
• Pre-procedure imaging tests (e.g., MRI, CT scans) and a biopsy are often required to plan the surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the site of the tumor.
3. The tumor, along with a margin of healthy tissue around it, is carefully excised.
4. Hemostasis is achieved to stop any bleeding.
5. The surgical site is closed with sutures or staples, and a drainage tube may be placed to prevent fluid accumulation.
6. The excised tissue is sent to a pathology lab to confirm complete removal and analyze the margins.

Tools and equipment: Scalpel, surgical clamps, suture materials, drainage tubes, electrocautery device.

Duration

The procedure typically takes between 1 to 3 hours, depending on the tumor's size and location.

Setting

Radical resection is performed in a hospital operating room.

Personnel

• Surgical oncologist or general surgeon
• Anesthesiologist
• Surgical nurses
• Potentially a pathologist for immediate assessment of excised tissue

Risks and Complications

• Common risks: Infection, bleeding, anesthesia-related complications.
• Rare complications: Nerve damage, significant blood loss, incomplete tumor removal.
• Management includes antibiotics for infection, blood transfusion if needed, and additional surgery if the tumor is not completely excised.

Benefits

• Removal of the malignant tumor with clear margins.
• Decreased risk of cancer recurrence in the affected area.
• Relief from symptoms caused by the tumor, such as pain or impaired function.

Recovery

• Post-surgery, patients may stay in the hospital for 1–3 days for monitoring.
• Pain management includes prescribed medications and possible use of a pain pump.
• Wound care instructions will be provided, emphasizing keeping the area clean and dry.
• Follow-up appointments are needed to monitor healing and receive pathology results.
• Full recovery can take several weeks to months, depending on the extent of surgery.

Alternatives

• Radiation therapy: Used when surgery isn't feasible or to shrink the tumor before surgery.
• Chemotherapy: May be employed for systemic treatment of cancer.
• Radiosurgical options: Less invasive but may not be suitable for large tumors.
• Each alternative has its pros and cons, related to effectiveness, duration, and side effects.

Patient Experience

• Patients will be under general anesthesia and feel no pain during the surgery.
• Post-operatively, there may be discomfort and soreness, managed with pain medications.
• Some temporary restrictions on physical activity will be necessary to allow healing.
• Gradual resumption of normal activities over weeks, as advised by the healthcare team.