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).