Home › Cancer Surgeries › Sarcoma & Rare Cancers
Cancer Surgery

Sarcoma &
Rare Cancers

Specialised surgical management of soft tissue sarcomas, bone tumours, skin cancers and melanoma, GIST, neuroendocrine tumours, and adrenal cancers — with a commitment to limb-sparing surgery, organ preservation, and the widest possible surgical margins that allow cure without unnecessary sacrifice of function.

Soft Tissue Sarcoma
Limb-Sparing Surgery
Skin Cancer & Melanoma
Electrochemotherapy
Training
Tata Memorial Hospital — Sarcoma & Reconstructive Oncology · 3 yrs Plastic Surgery Sassoon
Pioneer
First Electrochemotherapy in Asia — 2013, Sahyadri Hospital, Pune
Scope of Practice

Rare & Specialised Cancers We Treat

These cancers are rare individually — but collectively form a significant proportion of a surgical oncologist's complex practice. Each demands a specific surgical philosophy, multidisciplinary planning, and often the most demanding reconstructive technique.

Soft Tissue Sarcoma

Liposarcoma, leiomyosarcoma, synovial sarcoma, MPNST, fibrosarcoma — wide excision with limb salvage

Bone Tumours

Osteosarcoma, Ewing's sarcoma, chondrosarcoma — limb-sparing resection, endoprosthetic reconstruction

Skin Cancer & Melanoma

BCC, SCC, Melanoma — wide excision, sentinel node biopsy, lymph node dissection, ECT for recurrent deposits

GIST, NETs & Rare

GIST, carcinoid, neuroendocrine tumours, adrenal cancer, retroperitoneal tumours — surgical + systemic approach

Most Common Sarcoma Type

Soft Tissue Sarcoma — Wide Excision & Limb Salvage

Soft tissue sarcomas (STS) arise from fat, muscle, nerve, blood vessels, and fibrous connective tissue — most commonly in the extremities, but also in the retroperitoneum and trunk. Surgery is the cornerstone of curative treatment — and the quality of the surgical margin is the single most important determinant of local recurrence and survival.

The guiding principle of sarcoma surgery is wide excision with negative margins — removing the tumour completely surrounded by a cuff of normal tissue. Unlike carcinomas, sarcomas have a pseudocapsule that is deceiving — tumour cells infiltrate beyond the visible edge, and shelling out along this pseudocapsule (marginal excision) results in local recurrence rates of 80–90%. True wide excision with a 1–2cm margin of normal tissue reduces local recurrence to <15%.

The great advance of the last three decades is limb-sparing surgery (limb-salvage) — the ability to remove the sarcoma while preserving the extremity. In the 1980s, amputations were the standard for extremity sarcomas. Today, >90% of extremity sarcomas are treated with limb-sparing surgery — achieving equivalent local control and survival to amputation, with profoundly better quality of life. This requires precise pre-operative planning (MRI staging of the tumour compartment, vascular anatomy assessment) and surgical expertise in wide compartmental excision and soft tissue reconstruction.

For high-grade extremity sarcomas ≥5cm, neoadjuvant radiotherapy (50 Gy preoperatively) followed by surgery is the standard — shrinking the tumour, sterilising the margins, and potentially allowing a narrower surgical margin to be oncologically safe. Adjuvant chemotherapy (ifosfamide + doxorubicin) is used for selected high-grade, large STS in young, fit patients.

Retroperitoneal Sarcoma — Special Considerations
Challenge
No natural compartment boundaries — tumour can expand to enormous size. Margin achievement limited by proximity to aorta, IVC, kidney, bowel.
Surgery
Extended resection — en-bloc removal of tumour with involved adjacent organs (kidney, colon, psoas) to achieve R0 or R1 margins. Multi-visceral resection in selected cases.
Adjuvant
Post-operative radiation for R1 margins where feasible. Clinical trial enrolment recommended for high-grade retroperitoneal STS at specialised centres.
Common Soft Tissue Sarcoma Types

Liposarcoma

Most common STS — fat cell origin. Retroperitoneum and thigh most common sites. Well-differentiated and dedifferentiated types. MDM2 amplification.

Variable Grade

Leiomyosarcoma

Smooth muscle origin — uterine, retroperitoneal, vascular. High-grade, aggressive. Chemotherapy-responsive (ifosfamide + doxorubicin) for metastatic disease.

High Grade

Synovial Sarcoma

Young adults — near joint spaces. SYT-SSX translocation. Highly chemotherapy-sensitive — neoadjuvant chemo + surgery improves limb-salvage rates.

High Grade

MPNST

Malignant Peripheral Nerve Sheath Tumour — associated with NF1 (neurofibromatosis type 1). Poor prognosis. Wide excision is critical.

High Grade

Fibrosarcoma

Fibrous tissue origin — adults. Wide spectrum from low-grade (dermatofibrosarcoma protuberans, DFSP) to high-grade fibrosarcoma. DFSP highly chemosensitive to Imatinib.

Variable Grade

Desmoid Tumour

Locally aggressive but non-metastasising — fibromatosis. Often abdominal wall or mesentery. Management: active surveillance (many regress) → sulindac/tamoxifen → surgery/RT for progressive disease. Imatinib for refractory cases.

Non-metastasising

Limb-Sparing Surgery — The Standard of Care

Over 90% of extremity sarcomas can today be treated with limb-preserving surgery rather than amputation — achieving equivalent or superior local control and survival, with dramatically better quality of life and function. This requires pre-operative MRI compartment planning, wide excision beyond the pseudocapsule, and immediate soft tissue reconstruction to cover the defect. Dr. Gore's 3 years of plastic and reconstructive surgery training at Sassoon General Hospital is directly applicable to the complex reconstructive needs after wide sarcoma excision — rotational muscle flaps, fasciocutaneous flaps, and when needed, free tissue transfer to cover exposed bone, neurovascular structures, or hardware.

>90%
Extremity sarcomas managed with limb salvage — amputation rarely needed
<15%
Local recurrence with wide negative margin excision
R0
The goal — no tumour at the resection margin microscopically
MRI
Pre-operative compartment planning guides every sarcoma excision
Bone Oncology

Bone Tumours — Limb Salvage & Reconstruction

Primary bone tumours are rare but require prompt diagnosis and specialised multidisciplinary management — combining oncological surgery with orthopaedic reconstruction. The goal, as with soft tissue sarcoma, is limb salvage wherever oncologically safe.

Osteosarcoma

Most common primary malignant bone tumour — predominantly affects adolescents and young adults. Metaphysis of long bones (distal femur, proximal tibia). Standard treatment: neoadjuvant chemotherapy (MAP — Methotrexate, Adriamycin, Cisplatin × 3 cycles) → limb-sparing resection → adjuvant chemotherapy. Histological response to neoadjuvant chemo (>90% necrosis) predicts excellent prognosis. Endoprosthetic reconstruction (expandable prosthesis in growing children) restores limb function after resection.

Neoadjuvant Chemo + Limb Salvage Surgery

Ewing's Sarcoma

Small round blue cell tumour — EWSR1-FLI1 translocation. Children and young adults. Diaphysis of long bones and flat bones (pelvis, ribs). Highly chemosensitive — neoadjuvant VIDE chemotherapy (Vincristine, Ifosfamide, Doxorubicin, Etoposide) followed by surgery or radiotherapy. Limb salvage in the majority. Radiotherapy used for unresectable sites or when wide margins cannot be achieved (pelvis, spine).

VIDE Chemotherapy + Surgery or Radiotherapy

Chondrosarcoma & Others

Chondrosarcoma — cartilage tumour of adults. Surgery is the only curative treatment — chemotherapy and radiation are ineffective. Wide surgical excision with negative margins is mandatory. Low-grade chondrosarcoma may be treated with intralesional curettage + bone cement; high-grade requires en-bloc resection. Giant cell tumour of bone (GCTB) — locally aggressive, RANKL pathway — denosumab for unresectable cases, curettage or resection for accessible disease.

Surgery — Primary Treatment
Skin Oncology

Skin Cancer & Melanoma Surgery

Skin cancers — from the largely curable BCC and SCC to the potentially lethal melanoma — are managed by surgical excision with appropriate margins. Advanced and recurrent cutaneous deposits are an important indication for Electrochemotherapy.

Skin cancer is the most common cancer globally, and India's burden of squamous cell carcinoma is particularly high — driven by sun exposure, tobacco use, and chronic wounds (Marjolin's ulcer). Surgery — wide local excision with histologically confirmed clear margins — is the primary curative modality for all skin cancers.

For melanoma, the sentinel lymph node biopsy (SLNB) is the critical staging procedure — identifying occult nodal metastases in 15–20% of intermediate-thickness melanomas. Positive SLNB guides decisions on completion lymph node dissection and adjuvant immunotherapy (Pembrolizumab, Nivolumab) or targeted therapy (BRAF + MEK inhibitors for BRAF V600E mutation).

For unresectable or recurrent cutaneous deposits — including fungating wound tumours, sarcoma recurrences, and skin metastases from various primaries — Electrochemotherapy (ECT) offers a powerful local treatment option. Dr. Gore pioneered ECT in Asia at Sahyadri Hospital in 2013 — using electric pulses to dramatically increase intracellular bleomycin concentration, achieving tumour destruction with minimal systemic toxicity.

Electrochemotherapy (ECT) — First in Asia 2013

Advanced local treatment for cutaneous and subcutaneous deposits — see the ECT page for full information

→

Basal Cell Carcinoma (BCC)

Most common skin cancer — sun-exposed areas of the face. Locally destructive but rarely metastasises. Wide local excision with 3–5mm margins curative in >98% of cases. Mohs surgery for recurrent or high-risk facial BCC. Vismodegib (Hedgehog pathway inhibitor) for locally advanced or metastatic BCC.

Squamous Cell Carcinoma (SCC)

From sun damage, chronic wounds (Marjolin's ulcer), HPV, tobacco. Wide excision with 1cm margins for low-risk; 2cm for high-risk (poorly differentiated, >2cm, perineural invasion). Elective or therapeutic lymph node dissection for high-risk SCC. ECT for unresectable deposits.

Melanoma

Most dangerous skin cancer — vertical growth phase predicts metastasis. Wide excision margins depend on Breslow thickness: <1mm → 1cm margin; 1–4mm → 2cm; >4mm → 2cm. Sentinel lymph node biopsy for T1b+ (intermediate thickness). Adjuvant immunotherapy (Pembrolizumab) for Stage III. BRAF/MEK inhibitors for metastatic BRAF-mutated melanoma.

Recurrent Cutaneous Deposits — ECT

For unresectable or multiply recurrent skin and subcutaneous tumour deposits — Electrochemotherapy delivers Bleomycin with electroporation, achieving >80% objective response in cutaneous metastases. Applicable to breast cancer skin recurrence, sarcoma, head & neck, and melanoma deposits.

Other Rare Cancers

GIST, Neuroendocrine Tumours & Other Rare Malignancies

Rare but important — each of these cancers has a distinct biology, specific surgical approach, and requires integration of targeted or hormonal systemic therapy with surgery.

GIST — Gastrointestinal Stromal Tumour

The most common GI mesenchymal tumour — arising from Cajal cells of the GI tract. Stomach (60%) and small intestine (30%) most common. KIT (CD117) or PDGFRA mutation — activating tyrosine kinase. Surgery is the primary curative treatment for localised GIST.

Surgical resection — wedge or segmental; avoid pseudocapsule rupture (intraperitoneal spillage worsens prognosis)
Neoadjuvant Imatinib (Gleevec) for large, borderline resectable, or rectal GIST — shrinks tumour to enable sphincter preservation
Adjuvant Imatinib — 3 years for intermediate/high-risk GIST after R0 resection
Sunitinib for Imatinib-resistant GIST; Ripretinib for fourth-line
KIT Mutation · Imatinib-Sensitive

Neuroendocrine Tumours (NETs)

A family of tumours arising from neuroendocrine cells — pancreatic NETs (PNETs), carcinoid (ileal, appendiceal, bronchial), and gastrinoma, insulinoma, glucagonoma. Graded by Ki-67: G1 (<3%), G2 (3–20%), G3 (>20%). Functional tumours cause characteristic syndromes.

Insulinoma — surgical enucleation; most are benign and cured
Ileal carcinoid — right hemicolectomy + mesenteric LND; liver metastases may be debulked for carcinoid syndrome
Pancreatic NETs — distal pancreatectomy or Whipple's depending on location; enucleation for small G1 tumours
Somatostatin analogues (Octreotide, Lanreotide) — symptom control and anti-proliferative for well-differentiated NETs
Surgical + Octreotide · PRRT Theranostics

Adrenal & Retroperitoneal Tumours

Adrenocortical carcinoma (ACC), phaeochromocytoma, and primary retroperitoneal tumours — each with specific surgical and peri-operative requirements. Phaeochromocytoma requires alpha-blockade (Phenoxybenzamine) for at least 10–14 days pre-operatively to prevent hypertensive crisis during surgical manipulation.

Adrenalectomy (laparoscopic or open) — for ACC and phaeochromocytoma; en-bloc adjacent organ resection for locally advanced ACC
Pre-operative alpha-blockade mandatory for phaeochromocytoma — anaesthetic mortality without it is 50%
Retroperitoneal tumours — compartment-based resection; involved kidney, colon, or psoas resected en-bloc for R0
Mitotane — adjuvant for high-risk adrenocortical carcinoma post-resection
Pre-op Alpha-Block · En-Bloc Resection
Philosophy

Four Principles That Guide Every Sarcoma & Rare Cancer Operation

Rare cancers require the same surgical rigour as common ones — and often more, because each patient may be the first person in their surgeon's experience with that specific tumour. These four principles govern every operation, regardless of tumour type.

R0 Always the Goal

No tumour at the surgical margin — confirmed intraoperatively by frozen section. No other surgical goal takes priority.

Preserve Limb & Function

Limb salvage and organ preservation — whenever oncologically safe. Quality of life matters alongside cure.

Multidisciplinary Planning

Every sarcoma and rare cancer is reviewed with medical oncology, radiation oncology, pathology, and radiology before surgery.

Reconstruct Immediately

Immediate reconstruction at the time of resection — reduces hospital stay, prevents contracture, restores function faster.

Patient Questions

Frequently Asked Questions

I have a soft tissue lump in my thigh that has grown over 3 months. Should I be worried?▼
Yes — a soft tissue mass in the thigh (or any extremity) that is growing, deep to the fascia, or larger than 5cm should be investigated promptly. These are the classical features that distinguish a sarcoma from a benign lipoma. The investigation of choice is MRI of the affected limb — which characterises the tumour's relationship to adjacent compartments, neurovascular structures, and bone. Do not have a biopsy performed before MRI, and do not have excision performed before a confirmed tissue diagnosis — an unplanned excision of a sarcoma (excision without sarcoma protocols) significantly worsens outcomes and may require amputation to achieve clear margins on re-excision.
Does a diagnosis of sarcoma mean I will lose my arm or leg?▼
No — over 90% of extremity sarcomas are managed today with limb-sparing surgery. Amputation is reserved for a small minority of cases where the tumour has directly invaded the neurovascular bundle (main artery and nerve) to such an extent that the limb cannot function after reconstruction, or where the patient's limb function would be better with a prosthesis than with a salvaged but functionally compromised limb. Limb-sparing surgery with neoadjuvant radiotherapy achieves equivalent survival outcomes to amputation — with the obvious advantage of keeping the limb.
What is a GIST and why is Imatinib important before surgery?▼
A GIST (Gastrointestinal Stromal Tumour) is a mesenchymal tumour of the GI tract driven by a KIT or PDGFRA gene mutation — making it uniquely sensitive to the targeted drug Imatinib (Gleevec). For large (≥5cm) or borderline resectable GISTs, 3–6 months of neoadjuvant Imatinib before surgery consistently shrinks the tumour — sometimes dramatically — enabling a smaller, safer resection, avoiding multi-organ resection, or converting an unresectable tumour to resectable. After surgery, adjuvant Imatinib for 3 years in intermediate/high-risk GIST reduces recurrence by approximately 50%. This is a paradigm case of targeted therapy transforming surgical outcomes.
I have melanoma. Does my lymph node need to be removed?▼
For melanoma with Breslow thickness ≥0.8mm (or thinner if ulcerated), sentinel lymph node biopsy (SLNB) is recommended — a minimally invasive procedure that identifies the first-draining lymph node using a radioactive tracer or ICG. If the sentinel node is negative, the remaining nodes are almost certainly negative and no further nodal surgery is required. If the sentinel node is positive, adjuvant immunotherapy (Pembrolizumab) is offered — and completion lymph node dissection is only considered in selected high-risk cases (most recent evidence shows it does not improve survival over SLNB alone). The SLNB result also guides the need for adjuvant systemic treatment.
What is Electrochemotherapy and when is it used for skin tumours?▼
Electrochemotherapy (ECT) uses brief, high-intensity electric pulses to dramatically increase the permeability of tumour cell membranes — allowing intracellular Bleomycin concentration to increase 1,000-fold or more. This achieves powerful local tumour destruction without the systemic toxicity of conventional chemotherapy. ECT is used for cutaneous and subcutaneous tumour deposits that are unresectable, multiply recurrent, or where surgery would create an unacceptable defect — including breast cancer chest wall recurrence, melanoma skin metastases, sarcoma recurrences, and head & neck cancer deposits. Dr. Gore performed the first ECT in Asia at Sahyadri Hospital, Pune in 2013, and has been using it in his practice since. Full information is available on the ECT page →
My CT shows an adrenal tumour. What happens next?▼
An adrenal incidentaloma (tumour found incidentally) requires two assessments: biochemical (is it functional — phaeochromocytoma, Cushing's, Conn's?) and radiological (is it malignant?). All adrenal masses must have phaeochromocytoma biochemically excluded before any surgical or interventional procedure — because undiagnosed phaeochromocytoma during anaesthesia or biopsy can trigger a lethal hypertensive crisis. If phaeochromocytoma is confirmed, 10–14 days of alpha-blockade (Phenoxybenzamine) is mandatory before surgery. Adrenocortical carcinoma (ACC) — large (>6cm), radiologically suspicious — requires adrenalectomy, often with adjacent organ resection to achieve R0 margins. CT-guided biopsy of adrenal masses is generally avoided due to the phaeochromocytoma risk.

Consult Dr. Gore for Sarcoma & Rare Cancers

A rare or complex cancer diagnosis deserves an expert second opinion before any surgery is planned. Dr. Gore reviews all sarcoma and rare cancer cases personally — including imaging, biopsy, and multidisciplinary input — before recommending the optimal surgical approach.

Book a Consultation Request Second Opinion

Other Cancer Surgeries & Techniques

Electrochemotherapy

HIPEC

GI & HPB Surgery

Thoracic Surgery

Cancer Investigations
#DrVinodGoreCancerSurgeon #DrVinodGoreOncologist #DrVinodGorePune #DrVinodGoreHadapsar #DrVinodGoreSilverLeafClinic #DrVinodGoreSahyadriHospital #DrVinodGoreAppointment #DrVinodGoreConsultation #DrVinodGoreReviews #DrVinodGoreContact #Cancersurgeonsin #SilverLeafClinicHadapsar #SilverLeafClinicPune #BestCancerClinicHadapsar #CancerCenterHadapsar #CancerSpecialistClinicPune #SurgicalOncologyClinicPune #ComprehensiveCancerCenterPune #CancerSurgeryCentreOfExcellencePune #RoboticSurgeryCentrePune #ArisRoboticCentrePune #FarisSurgeonPune #EctCentrePune #CancerSurgeryPuneIndia #InternationalCancerSurgeonIndia #NriCancerTreatmentPune #MedicalTourismCancerPune #CancerTreatmentForForeignersPune #BestCancerHospitalInIndiaPune #CancerTreatmentCenterIndia #ExcellenceInCancerSurgeryPune #CancerTreatmentSpecialistIndia #CentreOfExcellenceOncologyPune #CancerSurgerySuccessRatePune #WorldClassCancerTreatmentPune #AffordableCancerTreatmentPune #QualityCancerTreatmentPune #CompassionateCancerCarePune #PatientFirstCancerHospitalPune #TrustedCancerTreatmentPune