not-yet-known not-yet-known not-yet-known unknown Panel deliberation. Approximately 15% % of patients with RMS present with obstruction symptoms secondary to tumor compressing nearby visceral drainage pathways. Biopsy and diversion when indicated is a less aggressive approach than debulking surgery. Debulking offers no survival advantage; however, the longer recovery and high risk of extensive resection are associated with undesirable delays in initiating chemotherapy64,65. For liver and biliary RMS presenting with biliary obstructive picture, surgery primarily serves diagnostic and staging purposes, as attempted resection often results in gross residual disease. Chemotherapy typically resolves biliary obstruction, making external drainage unnecessary and often complicated66.