Name of the Procedure:

Radical resection of tumor (e.g., sarcoma), soft tissue of shoulder area; 5 cm or greater

Summary

Radical resection of a tumor in the soft tissue of the shoulder area involves surgically removing a substantial portion of tissue containing cancer (such as a sarcoma) to ensure complete excision and to reduce the risk of the cancer spreading or returning.

Purpose

The procedure targets malignant tumors in the soft tissue of the shoulder area. The main goals are to remove the cancerous tissue completely, prevent recurrence, and ideally, preserve as much normal function and appearance of the shoulder as possible.

Indications

• Presence of a soft tissue sarcoma in the shoulder region measuring 5 cm or greater.
• Rapidly growing or symptomatic tumor.
• Biopsy-confirmed malignancy.
• Failure of other treatments, such as chemotherapy or radiation.

Preparation

• Preoperative assessments, including imaging studies like MRI or CT scans to determine the exact size and location of the tumor.
• Fasting for a specified period before surgery.
• Adjustments to current medications, particularly those affecting blood clotting, as advised by the physician.
• Pre-anesthesia evaluation to plan for the appropriate anesthesia.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia to ensure they are asleep and pain-free during the procedure.
2. Incision: A surgical incision is made over the shoulder area where the tumor is located.
3. Excision: The surgeon carefully excises the tumor along with a margin of healthy tissue to ensure all cancerous cells are removed.
4. Reconstruction: Depending on the extent of surgery, the surgeon may also perform reconstructive techniques to repair the area.
5. Closing: The incision is closed using sutures or staples, and a sterile dressing is applied.

• Tools: Surgical knives, scissors, electrosurgical devices, and possibly imaging tools to guide the surgery.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of the tumor.

Setting

The surgery is performed in a hospital setting, specifically in an operating room within the surgical department.

Personnel

• Lead Surgeon (specialized in oncologic surgery)
• Surgical Assistants
• Anesthesiologist
• Operating Room Nurses
• Possible involvement of a reconstructive surgeon if necessary

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Damage to surrounding tissues, including nerves and muscles
• Postoperative pain and swelling
• Risk of recurrence if all cancer cells are not removed
• Blood clots or deep vein thrombosis (DVT)

Benefits

• Complete removal of the tumor.
• Reduced risk of cancer recurrence or spread.
• Potential for significant improvement in symptoms and quality of life.

Recovery

• Initial hospital stay of 2 to 5 days post-surgery.
• Wound care and pain management instructions will be provided.
• Physical therapy may be necessary to regain shoulder function.
• Restrictions on heavy lifting and strenuous activities for several weeks.
• Follow-up appointments for monitoring healing and checking for any recurrence.

Alternatives

• Radiation therapy to shrink the tumor before considering surgery.
• Chemotherapy to target systemic spread or smaller tumors.
• Limb-sparing surgeries or less radical resections for smaller tumors.

Patient Experience

During the procedure, the patient will be under general anesthesia and remain unconscious. Postoperatively, they may experience pain, which will be managed with medications. Discomfort, swelling, and limited shoulder mobility are expected initially but will improve with time and proper rehabilitation. Frequent follow-ups with the surgical and oncology team will be part of the recovery process.