What is the role of surgical margin status in the operative treatment of pediatric rhabdomyosarcoma (RMS)?

Updated: Mar 28, 2019
  • Author: Roshni Dasgupta, MD, MPH; Chief Editor: Eugene S Kim, MD, FACS, FAAP  more...
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Answer

Preoperatively, all radiographic studies should be reviewed for evidence of metastases or signs of local invasion that may complicate resection. The surgeon should be prepared to perform a complete resection, when indicated, in order to afford the child the best possible prognosis.

If surgical margin status in unclear or a biopsy was initially performed for the tumor and the surgeon believes that it is possible to achieve complete tumor excision prior to chemotherapy, pretreatment reexcision (PRE) is recommended, including a wide reexcision of the operative site with adequate margins. This is most commonly seen with extremity and trunk lesions, and if negative margins can be obtained, the patient would be considered group 1.

Regardless of the tumor site, the surgeon should strive for a complete resection, without causing mutilation or disability. When the margins are in doubt, frozen sections should be sent for analysis. Frequently, major neurovascular structures are in the resection field. When these structures are essential, a careful resection should be undertaken to remove as much of the tumor as possible. In these cases, brachytherapy, intraoperative RT, or postoperative RT may be beneficial. Studies suggest that debulking has no advantage over biopsy in terms of survival. [35]


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