The survival rate for rhabdomyosarcoma (RMS) has significantly improved after the introduction of combined multimodality treatment. We report the 20-year treatment outcome of pediatric rhabdomyosarcoma in a single institution. The medical records of 16 patients treated for rhabdomyosarcoma between December 1986 and August 2007 at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were retrospectively reviewed. Mean age at diagnosis was 7.1 years (range: 1.3 -14.2 years). Retroperitoneum was the most common primary site (n=7, 43.8%), and embryonal type was predominant (n=11, 6%). Before the treatment, most patients were in advanced TNM stage (stage III 50%, IV; 25%). The patient distribution according to the Intergroup Rhabdomyosarcoma Study Clinical Grouping System (IRS-CGS) was as follows; Group I 31.3%, Group II 12.5%, Group III 31.3% and Group IV 25%. Patients were classified into three groups according to the extent of resection of the primary tumor; complete resection (CR, n=5; 31.3%), gross total resection (GTR, n=7; 43.8%) and incomplete resection (IR, n=4; 25%). Recurrence was observed in 9 patients (56.3%) while there was no recurrence in CR patients. All patients with recurrence were identified as moderate or high-risk according to the IRS-V Risk Group. Pre-treatment TNM stage of RMS in our institution was advanced with aggressive clinical feature, however post- surgical conditions according to IRS-CGS were similar to the previous reports by IRS. This suggests that down-staging of IRS-CGS was achieved with multimodality treatment with CR or GTR. It also suggests that complete resection is the most important prognostic factor in the treatment of RMS in children. Patients classified as moderate or high-risk need close follow-up due to high recurrence rate. In case of localized recurrence, better outcome may be achieved with multimodality treatment including limited surgery.