Surgery for Bone Sarcoma

Surgery for adult bone sarcoma involves removing the tumor, along with some surrounding healthy tissue, to ensure that the entire growth is gone. Depending on how close the sarcoma is to vital organs, complete removal of the tumor may not be possible. As a result, your doctors may recommend radiation therapy or, less frequently, chemotherapy after surgery to help destroy remaining cancer cells.

Other factors, such as the tumor type, size, and characteristics under the microscope, help to influence the treatment plan after surgery. For some types of sarcoma—such as benign, or noncancerous, tumors and chondrosarcoma—surgery may be the only treatment you need. For some subtypes—for example, giant cell tumors—surgery is often the first treatment of choice.

There is now effective medication that can shrink giant cell tumors that are too large to remove, with the hope of making them surgically manageable.

Although sarcomas are relatively uncommon tumors, they can require complex surgery. A team of surgical experts and other specialists at NYU Langone collaborates to manage these tumors, and specialize in treating people who have advanced bone sarcoma. For example, if the tumor wraps around important blood vessels, a vascular surgeon may join your cancer care team. If important nerves are being crowded or pressed on by the tumor, a neurosurgeon may help with surgery.

Sarcoma of the Limbs

When bone sarcoma is found in the arm or leg, our doctors make every effort to perform limb-sparing surgery—removing the tumor while leaving the rest of the affected limb intact.

Limb-Sparing Surgery

A group of surgical oncologists and orthopedic oncologists at NYU Langone focuses on surgery for people with bone sarcoma. For people with tumors in the arms and legs, this means limb-sparing surgery is often an option.

Your surgeon may remove and replace sections of bone with a prosthesis, a device made of metal and plastic, or with bone from a cadaver.

Sometimes, a large section of surrounding soft tissue needs to be removed along with the bone tumor. If this is necessary, the reconstructive surgeon may use a flap, or a portion of muscle and tissue from a nearby or other part of the body, such as the abdomen or back, to cover and repair the opening.

Surgeons can sometimes move this flap of tissue without cutting its original blood supply. However, they may need to cut the blood vessels, along with the tissue flap, and carefully reattach the vessels at the site where tissue has been removed.

Surgeons can also make a flap functional in its new location by attaching it to existing nerves in the arm or leg or by using nerve grafts, which are portions of unrelated nerves removed from another part of the body.

Limb-sparing surgery is often followed by evaluation by a doctor at NYU Langone’s Rusk Rehabilitation. They can prescribe physical and occupational therapy to help restore function to the arm or leg, so that you can return to your daily activities.

Limb Amputation

If the cancer is too big or wraps around important blood vessels, nerves, or other structures and cannot be removed with limb-sparing approaches, your surgical team may need to remove the arm or leg.

Afterward, you have the option of being fitted with a prosthetic limb. Our Rusk Rehabilitation doctors can ensure you receive one that best matches your level of physical activity.

Our doctors recommend physical therapy, occupational therapy, and other rehabilitative techniques. They also offer ongoing psychological support to help you become comfortable with the prosthetic as you return to your daily routine.

Other Tumor Sites

Although rare, bone sarcomas may occur in the head and neck, at the base of the skull, in the pelvis, or in the chest wall. These tumors are often managed with surgery but, as with other sarcomas, may also require radiation therapy or chemotherapy.

Head and Neck Sarcoma

Sarcoma can sometimes develop in the bones of the head and neck. Osteosarcoma, for instance, can develop in the jawbone. These tumors are often managed with surgery that may require reconstruction of the jawbone after tumor removal. NYU Langone doctors can reconstruct the jawbone using bones from the leg and are pioneers in planning surgery using computer-generated, three-dimensional models.

Other bones in the face can also be reconstructed. For example, the cheekbones, eye sockets, or the palate, which is the roof of the mouth, can be replaced with bones from other parts of the body. These bones may come from the leg, the forearm, or scapula, which is the shoulder blade.

Sarcoma of the Skull

Sarcomas, mostly chordomas, can occur in the bones at the base of the skull. To remove skull base tumors, our surgeons may use an endoscope, which is a long, thin, lighted tube with a tiny camera on it that allows them to see inside the body.

Surgeons place the endoscope through the nose and sinuses—which are the air-filled cavities on either side of the nose—and into the skull base. Surgeons then place small instruments through the endoscope and into the skull base to remove the tumor.

Sometimes, open surgery, called a craniotomy, may be used to remove tumors in the skull. In craniotomy, surgeons make an incision in the scalp and remove a small part of the skull to create an opening through which to access the tumor. They then remove as much of the growth as possible.

Spine and Sacrum Sarcoma

Tumors that occur in the spine—for example, chordomas—may require the removal of one or two vertebrae, the bones that make up the spine, to ensure the complete removal of the cancer.

Those that occur in the sacrum, a larger triangular bone at the end of the spine, may necessitate removal of part of the sacrum or the entire bone, followed by reconstruction of the involved bones and surrounding soft tissue.

Pelvic Sarcomas

Some bone sarcomas—for example, chondrosarcomas and osteosarcomas—develop in the pelvic bones. These tumors tend to be large by the time they are detected, making reconstructive surgery an important part of treatment.

After NYU Langone’s orthopedic surgeons remove the tumor and a margin of healthy tissue, reconstructive surgeons may take bone from the leg to reconstruct the pelvis. Other options include using bones from a donor or a special molded composite to replace the bones in the pelvis.

Chest Wall Sarcomas

The chest wall consists of muscle, tissue, and bones, including the ribs and sternum, that protect the organs in the chest cavity.

When a sarcoma develops in the bones of the chest wall, our thoracic surgeons work to remove the tumor and a margin of surrounding healthy tissue while protecting the area’s vital organs, including the lungs and heart.

Rehabilitation After Surgery

Your hospital stay and recovery after sarcoma surgery depend on the type of surgery you have and your overall health. If you undergo limb-sparing surgery or amputation, with or without reconstruction, a Rusk Rehabilitation doctor evaluates you. He or she may prescribe physical and occupational therapy and psychological support, services that are available onsite at Rusk.

Our rehabilitation experts can ensure you receive the support and follow-up care you need to regain your independence.