Pediatric cancer surgery is a specialized field that focuses on the surgical removal of tumors in children, from newborns to adolescents. It is often combined with chemotherapy, radiation therapy, and targeted treatments to ensure the best possible outcome. Pediatric surgical oncologists work closely with pediatric oncologists, radiologists, pathologists, and intensive care specialists to develop personalized treatment plans.

1. Types of Pediatric Cancers Requiring Surgery

A. Solid Tumors in the Abdomen & Pelvis

1. Wilms Tumor (Nephroblastoma)
   • Origin: Kidney
   • Treatment: Nephrectomy (kidney removal), sometimes partial kidney removal in smaller tumors.
   • Survival Rate: ~90% with surgery + chemotherapy.
2. Neuroblastoma
   • Origin: Nerve tissue (commonly in the adrenal glands)
   • Treatment: Tumor resection, often combined with chemotherapy.
   • High-risk Cases: May require bone marrow transplant after surgery.
3. Hepatoblastoma & Hepatocellular Carcinoma (Liver Cancer)
   • Origin: Liver
   • Treatment: Liver tumor resection or liver transplant in advanced cases.
4. Rhabdomyosarcoma (Soft Tissue Cancer)
   • Origin: Muscles, tendons, or connective tissues
   • Treatment: Surgery combined with chemotherapy/radiation.

B. Brain & Spinal Cord Tumors

1. Medulloblastoma (Most Common Brain Cancer in Kids)
   • Treatment: Craniotomy & tumor resection, followed by radiation/chemotherapy.
2. Gliomas & Astrocytomas
   • Treatment: Partial or total tumor removal; difficult-to-reach tumors may be treated with targeted therapies.
3. Ependymomas (Brain & Spinal Tumors)
   • Treatment: Surgical removal + radiation therapy for complete eradication.

C. Thoracic (Chest) & Bone Tumors

1. Ewing Sarcoma & Osteosarcoma
   • Origin: Bones (often in arms, legs, or pelvis)
   • Treatment: Limb-sparing surgery or amputation if necessary, followed by chemotherapy.
2. Germ Cell Tumors (Testicular or Ovarian Tumors)
   • Treatment: Surgical removal; chemotherapy in malignant cases.

2. Pediatric Cancer Surgery Techniques

A. Open Surgery (Traditional Surgery)

• Used for large tumors, deep-seated cancers, and complex surgeries like nephrectomy (kidney removal) or hepatectomy (liver tumor removal).

B. Minimally Invasive Surgery (Laparoscopy & Thoracoscopy)

• Used for small, localized tumors to reduce pain, scarring, and recovery time.
• Common in kidney, liver, and ovarian tumors.

C. Limb-Sparing Surgery for Bone Cancers

• In cases of osteosarcoma & Ewing sarcoma, instead of amputation, surgeons remove the affected bone and replace it with an implant or bone graft.

D. Fetal Surgery for Rare Tumors

• Some tumors, like sacrococcygeal teratoma, can be partially treated before birth to improve survival rates.

3. Post-Surgical Care & Recovery

A. Immediate Postoperative Care

• ICU Monitoring: Some children may need ventilator support in complex surgeries.
• Pain Management: Medications to ensure comfort.
• Nutritional Support: Some children may need feeding tubes if they cannot eat after surgery.

B. Long-Term Follow-Up

• Physical Therapy: Especially after limb-sparing surgeries or brain tumor removals.
• Regular Scans (MRI/CT/PET): To detect recurrences or complications.
• Psychosocial Support: Counseling for both the child and family.

4. Advances in Pediatric Cancer Surgery

1. Robotic-Assisted Surgery – Offers better precision in delicate areas (e.g., brain & spine tumors).
2. 3D Imaging & AI in Tumor Mapping – Helps plan complex surgeries with greater accuracy.
3. Targeted Therapy & Immunotherapy – Combined with surgery for aggressive cancers.

5. Prognosis & Survival Rates

• Wilms Tumor → ~90% survival with surgery & chemotherapy.
• Neuroblastoma → Early-stage: 95% survival, High-risk: 50-70%.
• Osteosarcoma & Ewing Sarcoma → 60-80% if localized, lower if spread.
• Brain Tumors (Medulloblastoma, Astrocytoma) → 50-80% depending on type & location.