Trends in surgery for childhood rhabdomyosarcoma

Total excision remains the aim of surgical management for rhabdomyosarcomas in children, but effective adjunctive treatment for the majority of these tumors permits preservation of function and appearance in situations where formerly these were sacrificed. Control of residual tumor in microscopic quantity can now be achieved by chemotherapy in the majority of cases. The coordination of surgery, irradiation, and chemotherapy has reduced the need for ultra-radical extirpative procedures. The following conservative trends have evolved: 1) Amputations are rarely indicated for tumors of the extremities. 2) Primary irradiation for orbital tumors may obviate exenteration and save the eye. 3) Multilating excisions for head and neck tumors can often be avoided. 4) Prophylactic regional lymph node dissections are usually not indicated. 5) Primary tumors of the bladder or prostate can usually be managed by anterior exenteration.