Background Soft tissue sarcomas (STS) are rare tumours that require multidisciplinary management at high-volume centres. The WA State Soft Tissue Sarcoma Service (WASTSS), established at Sir Charles Gairdner Hospital in 2016, provides a central referral pathway for rural patients. This study evaluated referral patterns and adherence to the Australian Cancer Council's optimal care pathway for people with sarcoma guidelines recommending specialist assessment within 4 weeks, investigations within 2 weeks, and surgery within 3 weeks of the decision to operate. Methods A retrospective analysis was conducted on 69 rural patients referred to WASTSS from 2020 to 2023. Data on demographics, referrals, and timelines were analysed. Statistical tests assessed adherence to guidelines and differences by patient and referrer location, malignancy status, and socio-economic factors. Results Annual referrals increased, with 88.2% of patients assessed within 4 weeks (median: 9 days). Investigations were completed within 2 weeks for 64.7% of patients (median: 7 days). Biopsy timing and location influenced investigation timelines. Only 37.5% of patients underwent surgery within 3 weeks, with delays linked to resource constraints and case complexity. Malignant cases experienced shorter delays than benign cases, with all malignant cases excised within 50 days; however, both groups exceeded recommended timeframes. Conclusion WASTSS met guidelines for initial assessments and investigations for rural patients in most cases. Delays in surgical management highlight the need for enhanced triage and resource allocation. Establishing dedicated benign tumour services and optimising diagnostic pathways could further improve outcomes.