DISCUSSION
This study convened a diverse international panel to develop evidence-based recommendations for the surgical management of rhabdomyosarcoma (RMS). Our effort underscores the importance of standardizing surgical practices in a condition where treatment approaches can significantly vary across different regions and healthcare systems. The panel formulated ten recommendations aimed at addressing critical questions identified by experts in the field, reflecting both clinical significance and the practical needs of diverse healthcare settings.
A notable limitation highlighted was the scarcity of robust evidence addressing the prioritized questions. Many existing studies were of low certainty, primarily retrospective cohort designs, which inherently have suboptimal rigor. This gap indicates a pressing need for well-designed and comprehensive international prospective studies to elucidate the true impact of various surgical interventions on outcomes in RMS. Future research should focus on generating higher-quality evidence that can more definitively guide surgical practices.
Despite the limitations in the evidence base, the recommendations provided by the panel are grounded in practical considerations. Most suggested interventions are consistent with standard care practices across various resource settings and do not impose additional risks to patients. For instance, the recommendation for regional lymph node evaluation is crucial, as our analysis indicates a potential survival benefit in patients with extremity and paratesticular RMS who are more than 10 years old. This is particularly relevant given the varied surgical approaches currently employed worldwide.
Moreover, the emphasis on pre-treatment re-excision for incompletely resected RMS reflects a growing understanding of the importance of achieving negative margins to minimize recurrence risk. Similarly, the suggestion for early preoperative radiation therapy in cases of unresectable RMS acknowledges the need for alternative strategies to enhance resectability and highlight the utility of radiation therapy as the primary local control modality when surgery is not feasible.
The global nature of this guideline development effort highlights its potential applicability across different healthcare settings. The recommendations aim to provide a framework for improving surgical outcomes in RMS, which can be adapted to local resources and practices. By promoting standardization, we hope to reduce disparities in care and outcomes for children with RMS worldwide.
As we look to the future, we encourage ongoing dialogue and collaboration among pediatric cancer care providers to refine these guidelines further. Regular updates, planned every four years, will ensure that our recommendations evolve alongside advancements in surgical management and evidence.
In conclusion, our panel’s recommendations for the surgical management of RMS are designed to bridge existing gaps in care and provide a foundation for enhancing surgical outcomes across diverse healthcare environments. By fostering a shared understanding and application of these guidelines, we aim to improve the prognosis for children affected by this challenging disease.