RECOMMENDATIONS
The panel recommends surgical evaluation of regional lymph nodes for
the management of paratesticular RMS who are more than 10 years old
and extremity RMS (Strong recommendation, Certainty of evidence:
Very Low, Supplemental Table S3).
We identified eight comparative studies assessing lymph node evaluation
versus no evaluation. However, after removing studies with patient
overlap, we included five retrospective cohort studies enrolling 2081
patients in the analysis. Pooled results did not show any difference in
mortality, event-free survival, or relapses for paratesticular RMS who
are more than 10 years old. However, overall mortality was lower in
those receiving lymph node evaluation compared to no evaluation (OR
0.46, 95% CI 0.22 to 0.96). In patients with RMS of extremities,
mortality was lower for those receiving lymph node evaluation (OR 0.32,
95% CI 0.17 to 0.60).