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Evidence-Based Surgical Guidelines for Treating Children with Rhabdomyosarcoma
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  • Abdelhafeez Abdelhafeez,
  • Tea Reljic,
  • Farina Klocksieben,
  • Ambuj Kumar,
  • Sharon Cox,
  • Andrew Davidoff,
  • Kudzayi Munanzvi,
  • Sheila Terwisscha van Scheltinga,
  • Ahmed Elgendy,
  • Justin Gerstle,
  • Bilal Mazhar Qureshi,
  • Abdulrasheed Nasir,
  • Timothy Lautz,
  • Amabelle Moreno,
  • Amos Loh,
  • Sajid Qureshi,
  • Gordan Vujanic,
  • Pablo Lobos,
  • Sheena Mukkada,
  • Simone Abib
Abdelhafeez Abdelhafeez
St Jude Children's Research Hospital

Corresponding Author:hafeez.abdelhafeez@stjude.org

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Tea Reljic
University of South Florida Morsani College of Medicine
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Farina Klocksieben
University of South Florida Morsani College of Medicine
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Ambuj Kumar
University of South Florida Morsani College of Medicine
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Sharon Cox
University of Cape Town Department of Surgery
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Andrew Davidoff
St Jude Children's Research Hospital
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Kudzayi Munanzvi
Harare Central Hospital
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Sheila Terwisscha van Scheltinga
Prinses Maxima Centrum voor Kinderoncologie BV
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Ahmed Elgendy
Tanta University
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Justin Gerstle
Memorial Sloan Kettering Cancer Center Department of Surgery
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Bilal Mazhar Qureshi
The Aga Khan University
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Abdulrasheed Nasir
University of Ilorin Teaching Hospital
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Timothy Lautz
Northwestern University Feinberg School of Medicine
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Amabelle Moreno
University of the Philippines-Philippine General Hospital Department of Surgery
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Amos Loh
KK Women's and Children's Hospital
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Sajid Qureshi
Tata Memorial Hospital Department of Surgery
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Gordan Vujanic
Sidra Medicine
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Pablo Lobos
Hospital Italiano de Buenos Aires
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Sheena Mukkada
St Jude Children's Research Hospital
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Simone Abib
Universidade Federal de Sao Paulo
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Abstract

Background: Surgery remains the cornerstone of treatment for rhabdomyosarcoma (RMS) in children. However, there is considerable variation in surgical management practices worldwide, highlighting the need for standardized clinical practice guidelines (CPG). Methods: The CPG development involved assembling a multidisciplinary group, prioritizing ten key topic areas, conducting evidence searches, and synthesizing findings. Recommendations were voted on using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. Recommendations: The panel recommended regional lymph node evaluation for patients with paratesticular RMS who are more than 10 years old and extremity RMS. Other suggestions included pre-treatment re-excision for incompletely resected RMS, preoperative radiation therapy for unresectable tumors, maintaining a 0.5 cm resection margin, and tumor bed marking with surgical clips. The panel also suggests resection of residual metastatic disease following chemotherapy, resection of relapsed disease, and the least invasive approach for managing patients presenting with obstruction. Conclusion: This CPG provides evidence-based surgical management recommendations for RMS that can be adapted to diverse resource settings.