Soft tissue sarcomas: How is the surgery performed?

Описание: Soft tissue sarcomas are a rare but diverse group of malignant tumors—and surgical treatment requires special expertise.
Professor Jakob clearly explains why early referral to the sarcoma center is so important, how biopsies are performed correctly, and why planning the surgery is crucial for the success of the treatment.
Learn what really matters in sarcoma surgery, what a so-called R0 resection means, and when additional radiation therapy or chemotherapy is necessary.
The interview also addresses typical questions such as:
When is surgery sufficient? When is radiation therapy used? What happens if the tumor cannot be completely removed?

The German original version can be found here:
   • Weichteilsarkome: Wie läuft die Operation ab?  

→ In the video: All steps of soft tissue sarcoma surgery explained in an understandable way

Soft tissue sarcomas (soft tissue tumors) are rare, often aggressive tumors that can develop in various parts of the body. In specialized sarcoma centers such as the Sarcoma Center Mannheim, experienced sarcoma surgeons such as Prof. Jakob perform complex diagnostics and treatment. Even if sarcoma is only suspected, the surgeon performs a targeted biopsy using special techniques such as the coaxial needle in order to optimally prepare for the subsequent surgical procedure.

Professor Jakob emphasizes that sarcoma surgery requires a high level of expertise. Careless removal of a suspected bruise can significantly worsen the prognosis. If soft tissue sarcoma is confirmed or even suspected, it is therefore essential to consult a specialized sarcoma center.

The surgical strategy depends on the type of tumor (e.g., well-differentiated liposarcoma, myxofibrosarcoma) and grading (degree of aggressiveness). While surgery alone is often sufficient for less aggressive tumors, more aggressive sarcomas require a combination of surgery and adjuvant or neoadjuvant radiation therapy.

Complete tumor removal with R0 status is particularly important – this means that the tumor has been removed with a healthy safety margin. In the case of R1 or R2 resections (tumor at or within the resection margin), follow-up surgery, radiation, or chemotherapy may be necessary. The pathologist examines each surgical specimen carefully and classifies the margin status.

The location also plays a major role:

Extremity sarcomas (e.g., on the arm or leg) can often be removed with a larger margin.
Retroperitoneal sarcomas in the abdomen require special planning because important organs and blood vessels are located close together.
Head and neck sarcomas also pose major surgical challenges.
The decision between primary surgery, preoperative (neoadjuvant) radiation therapy, or adjuvant (postoperative) radiation depends on the tumor biology, location, and individual risk factors, such as existing diabetes or wound healing disorders.

Successful sarcoma surgery is followed by structured aftercare:

Early mobilization
Pain management
Wound checks until the third week
Physical therapy and subsequent rehabilitation
A common problem after surgery on the extremities is lymphedema. However, the risk of lymphatic congestion can be reduced through consistent compression bandaging, compression stockings, and targeted lymphatic drainage.

Overall, the goal of any sarcoma surgery is complete tumor removal with maximum preservation of function—and this is always discussed individually with each patient at the Sarcoma Center Mannheim.

→ In the film, Prof. Jakob explains all the steps involved in sarcoma treatment: from diagnosis to surgery to aftercare.

With Prof. Dr. Jens Jakob (University Hospital Mannheim) and Karin Strube (Strube Foundation)
A film by the Strube Foundation in cooperation with the German Sarcoma Foundation.
Consultation by patient representatives: Susanne Gutermuth and Odette Helbig.
Coordination by Katja Winter


0:00 Intro
0:43 Early contact with the sarcoma center is important
5:53 When surgery alone is sufficient
7:55 Aggressive tumors require combined therapies
8:43 Advantages and disadvantages of radiation therapy before surgery
12:46 Goal of surgery: tumor-free and functional preservation
15:40 R0, R1, R2, and RX
22:18 Making individual decisions together
23:26 Lymph nodes rarely play a role
24:32 The importance of tumor location
30:00 After surgery: wound healing, rehabilitation, and follow-up care
32:33 Lymphedema: an underestimated problem