In sarcoma surgery, the first operation is the one that decides everything. We make it count.
These rare tumours of muscle, bone and connective tissue punish casual handling: a lump shelled out without planning seeds recurrence and can cost a limb later. Here, imaging comes before biopsy, biopsy before surgery, and margins are planned like the outcome depends on them — because it does.
What are sarcomas?
Sarcomas arise from the body’s scaffolding — muscle, fat, nerve, vessel, bone. They are rare (which is why general surgeons may meet only a handful in a career) and they behave differently from organ cancers: they spread along tissue planes rather than through pipes, and their cure lives or dies on the quality of the first resection.
The tragedy this service exists to prevent has a name in the trade: the ‘whoops procedure’ — a lump enucleated casually as a harmless lipoma, found on histology to be sarcoma, leaving tumour cells scattered along the track. Salvage after that is harder for everyone. A second opinion before the FIRST cut is not caution here; it is the standard of care.
Bone sarcomas (osteosarcoma, Ewing sarcoma) are handled jointly with orthopaedic oncology colleagues; GISTs follow their own targeted-therapy pathway where tablets do much of the work.
“Bring us the lump before someone removes it — or bring us the pathology if they already did. Both arrive here every week.”
તમે એકલા નથી — you are not alone with something this rare. We coordinate every scan and biopsy for you.
Eight signs a lump needs more than reassurance
Most lumps are innocent lipomas — truly. But size, depth and behaviour decide, and those three things are settled by examination and one good MRI, not by waiting another year.
- ①A lump that keeps growing, however slowly — growth is data.
- ②Any lump deeper than the skin, larger than five centimetres — roughly a lime; this size deserves an MRI regardless of feel.
- ③A lump that hurts, especially at night or with use.
- ④A lump that came back after previous removal — recurrence changes the rules entirely.
- ⑤Swelling of a limb without injury, persistent or worsening.
- ⑥A lump already removed as ‘fatty’ whose report says otherwise — bring the slides; timing still matters.
- ⑦Persistent bone pain in a young person, worse at night and blamed on sports or growing — it deserves an X-ray minimum.
- ⑧Any deep lump you have been told to simply watch without imaging — watching without measuring is not surveillance.
Tumours we treat
◆Soft-Tissue Sarcoma — Limb & Trunk
Wide compartment-aware excision planned off MRI, with function preserved deliberately.
◆Retroperitoneal Sarcoma
Deep abdominal tumours requiring multivisceral resection — planned organ by organ beforehand.
◆Osteosarcoma
Managed jointly with orthopaedic oncology — chemotherapy-first protocols, then definitive surgery.
◆Ewing Sarcoma
Protocol-driven combined treatment coordinated across specialties from day one.
◆Desmoid Tumours
Not quite cancer, never trivial — managed with restraint, medication or surgery as each case merits.
◆GIST
Stomach and bowel stromal tumours — surgery plus targeted tablets that transformed this disease.
Operations performed here
- ◆Wide excision, compartment-awareMargins designed around the tumour’s biology and the anatomy it sits in — drawn on MRI before the knife.
- ◆Limb-salvage surgeryCure AND a working limb pursued together; amputation is the last resort, discussed honestly when truly on the table.
- ◆Retroperitoneal multivisceral resectionDeep tumours removed together with organs they touch, planned so nothing is improvised mid-operation.
- ◆Re-excision of ‘whoops’ casesRescue operations after unplanned removals — scar tract included, done to full sarcoma standard.
- ◆Coordinated radiotherapy / chemotherapy pathwaysSome sarcomas shrink best before surgery; the sequence is set with medical and radiation oncology upfront.
- ◆GIST managementResection plus tyrosine-kinase-inhibitor therapy pathways, including mutation-guided choices.
From first visit to full recovery
MRI before anything else
The lump characterised properly — size, depth, plane — because biopsy choice depends on it.
Biopsy along future lines
Needle or incision placed so it can be removed WITH the tumour later — small detail, large consequences.
Sarcoma multidisciplinary board
Orthopaedic oncology, radiation, medical oncology and pathology review together before plans harden.
Surgery to plan
Wide margins achieved as drawn; reconstruction arranged where tissue must be replaced.
Function rehabilitation
Physiotherapy aimed at returning strength — a salvaged limb is measured by what it can do.
Tight surveillance
Sarcomas recur locally if they recur — scheduled reviews catch anything early enough to beat again.
Families usually ask…
Because in sarcoma there is no undo button. A casually removed lump scatters cells along its track; the salvage operation then removes far more tissue, sometimes with radiotherapy added, sometimes threatening the limb. One pre-operative consultation here — MRI reviewed, biopsy routed correctly — prevents most of that. It costs days; skipping it can cost function.
The strong default today is limb salvage — most limb sarcomas are cured while keeping the limb, using wide excision with reconstruction. Amputation remains necessary occasionally; when it is genuinely the safer path you will hear why in detail, with alternatives shown. Fear should come from facts, not from old stories.
Removing the tumour surrounded by a cuff of healthy tissue in every direction — because sarcoma cells extend invisibly beyond what fingers feel. Shelling the lump out leaves those cells behind; wide margins leave them on the table. Margin quality on your final pathology report is among the strongest predictors of staying cured.
It behaves like cancer — it can grow, invade and spread — but it responds remarkably to targeted tablets (imatinib-class medicines) that ordinary chemotherapies cannot match. Many GIST patients live long, normal lives on daily medication after surgery. It is a serious diagnosis with unusually good modern answers.
No — this situation arrives weekly and has a defined playbook: obtain the original slides and scans, restage, then plan re-excision that includes the previous scar tract to full margins. Outcomes after proper rescue remain good. Bring whatever paperwork exists; we take coordination from there.