Initial surgery for localized rhabdomyosarcoma: a report from the Italian Soft Tissue Sarcoma Cooperative Group Studies

Objective. Analysis of the initial surgical approach in patients with localized rhabdomyosarcoma, enrolled in Italian Studies (1979-2003). Methods. Surgical records of 587 patients were evaluated. As primary surgery, the excision was recommended if microscopically complete, otherwise biopsy was preferable. Results. The initial biopsy, performed in almost 50% of patients in RMS-79 protocol, has been adopted more often in the protocol RMS-88 and 96. However, the "complete resection" rate has remained quite stable through the years, as well as the percentage of microscopic residue. The macroscopic residue disease has been more important in RMS-88 study than in RMS-96. Most GUnBP tumors and about 10% of HNnPM and other site were successfully excised. A complete resection was rarely attempted in orbit, HNPM, and GUBP sites; regarding the extremities tumors, 62.5% of patients in RMS-79 study underwent a complete conservative excision, while most patients in RMS-88 and 96 underwent biopsy only. Conclusion. Initial surgical approach has become more conservative, avoiding mutilations, but the incomplete resection rate is still high. A satisfactory initial excision was obtained in GUnBP RMS (mainly paratesticular). In other localizations the feasibility of a complete resection was slightly better for T1a RMS; a careful preoperative evaluation is always necessary