An analysis of US national data has revealed that nearly half of sarcoma surgeries are carried out by surgeons not specialized in removing the cancer.

The data, analyzed by researchers at UC Davis in California and published published online in the Journal of Surgical Oncology, revealed that orthopedic oncologists and surgical oncologists, who are specially trained to carry out the complex procedures of removing sarcomas, do only 52% of the operations.

The operations to remove sarcomas – tumors located deep in the muscles and other soft tissues of the limbs – were carried out at 85 academic medical centers over a three-year period.

The remaining 48% of the sarcoma surgeries were carried out by general surgeons, plastic surgeons and orthopedic surgeons.

New cancer treatment guidelines from the US National Comprehensive Cancer Network and European Society of Medical Oncology in 2012 – recommend that only surgeons who have expertise in the area of sarcoma tumors should operate on them.

The data show that between 2007 and 2009, sarcoma surgeries were carried out 2,195 general surgeons, 1,979 general orthopedic surgeons, 792 plastic surgeons, 533 surgical oncologists and 83 orthopedic oncologists.

According to Robert J. Canter, associate professor of surgery at UC Davis, the post-medical degree fellowship training of these surgeons would not have fully taught the surgical management of sarcomas or other cancers embedded deep in the soft tissues of limbs.

According to figures from the American Cancer Society, this year there are likely to be 11,410 new cases of soft tissue sarcomas in the US and 4,390 deaths. Canter says that around 50% of these sarcomas will appear in the limbs. He adds that around 50% of these sarcomas are also at risk of spreading to other parts of the body.

Canter says of the data:

“Our findings may have significant implications for the quality of care provided to patients who undergo surgery to resect, or remove, sarcomas in the deep soft tissue of the limbs.”

He says that only orthopedic oncologists and surgical oncologists have been trained to carry out this procedure without leaving behind cancerous cells that could lead to the development of another tumor.

He adds that patients whose sarcomas are not diagnosed until after surgery may require a second operation to ensure that all remaining cancer cells are removed, putting the patient at further risk of surgical complications.

Canter points out that when a tumor is diagnosed before an operation, an orthopedic or surgical oncologist can carefully evaluate the cancer, helping to analyze whether chemotherapy or radiation will be needed. He says this also helps plan whether a vascular or plastic surgeon is needed to join the surgical team.

A pre-surgical “evaluation and planning period” is needed for each patient, Canter says, which will also take into account whether the patient will need occupational or physical therapy.

Additionally, he adds that a sarcoma can be diagnosed before surgery with a needle biopsy, but because sarcomas are rare, many surgeons who do not specialize in this area may skip the test and go into theatre without knowing that a tumor is a sarcoma.