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Childhood Cancer Care — Surgical Oncology

Surgery for childhood cancer — limb-sparing & organ-sparing explained for parents

Medically reviewed by Dr. Muralidhar Muddusetty, MS (Surgical Oncology) · Last reviewed June 2026

When your child is diagnosed with cancer, the word “surgery” can feel overwhelming. It doesn’t have to. Child cancer surgery today is guided by one principle: remove the tumour completely, while protecting as much healthy tissue as possible. That means limb-sparing surgery for bone tumours, organ-sparing approaches for kidney, liver, and eye tumours, and careful multi-disciplinary planning before any operation begins. This page explains the main types of pediatric cancer surgery, how the decision is made, what to expect before and after the operation, and how CION co-ordinates the surgical journey from diagnosis to recovery.

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Pediatric Surgical Oncology

Types of surgery used in childhood cancer

Surgery plays a different role depending on the cancer type. For some tumours it is the first step. For others it follows chemotherapy. Understanding which type of surgery your child’s team is recommending — and why — helps you ask the right questions.

Most common solid tumours

Tumour resection (removal)

The main surgical goal in childhood solid tumours is removing the entire primary tumour with a clear margin of healthy tissue around it. Whether the surgeon can achieve this in one operation, or whether chemotherapy is needed first to shrink the tumour, depends on the size and position of the cancer.

  • Used for Wilms tumour, neuroblastoma, hepatoblastoma, rhabdomyosarcoma
  • Chemotherapy may be given before surgery to reduce tumour size first
  • A tumour-free surgical margin is the primary goal of every resection
  • Pathologist confirms clear margins on the removed specimen after surgery
Bone tumours — osteosarcoma, Ewing sarcoma

Limb-sparing surgery

Limb-sparing surgery (limb-salvage surgery) removes a bone tumour from the arm or leg while preserving the limb. The removed bone is replaced with a metal implant, a bone graft, or an expandable prosthesis designed to grow with the child. It has become the standard approach for most children with bone sarcomas.

  • Replaces amputation in most eligible cases at specialist centres
  • Expandable implants accommodate the child’s ongoing growth
  • Pre-operative chemotherapy helps shrink the tumour before surgery
  • Physiotherapy begins within days of surgery to restore function
Kidney, liver & eye tumours

Organ-sparing (nephron-sparing) surgery

Where the tumour can be fully removed while leaving enough healthy organ to function, surgeons aim to spare the organ rather than remove it entirely. This is especially important for children, who will rely on their organs for a lifetime after cancer treatment.

  • Partial nephrectomy (kidney-sparing) for Wilms tumour where safe
  • Partial liver resection for hepatoblastoma after chemotherapy response
  • Eye-sparing approaches for retinoblastoma in eligible cases
  • Feasibility depends on tumour response to pre-operative chemotherapy
Diagnosis step — all cancers

Biopsy

A biopsy is the procedure that confirms the cancer diagnosis. A small sample of tumour tissue is removed and examined by a pathologist. It is usually the first surgical procedure a child has, and it must be done carefully — a poorly placed biopsy can complicate later limb-sparing surgery in bone tumours.

  • Core needle biopsy: a needle removes a small cylinder of tumour tissue
  • Incisional biopsy: a small cut is made to take a tissue sample directly
  • Must be planned by the treating surgeon, especially for bone tumours
  • Guides the entire treatment plan, including which chemotherapy is used
Supporting the treatment journey

Central venous port insertion

Most children receiving chemotherapy have a small device called a port (or PORT-A-CATH) placed under the skin of the chest. It provides reliable venous access for chemotherapy, blood tests, and fluids without repeated needle sticks, which is especially important for young children over months of treatment.

  • Short procedure, usually done under general anaesthesia
  • Reduces the discomfort of multiple needle insertions during treatment
  • Accessed with a special needle through the skin when needed
  • Removed at the end of treatment once the team confirms it is safe to do so
After initial treatment

Second-look and delayed surgery

In some tumours, a second operation is planned after an initial course of chemotherapy. This may be to re-evaluate whether a tumour that was initially inoperable has responded enough to be removed, or to check whether any residual disease remains after the initial operation and chemotherapy.

  • Common in neuroblastoma after initial chemotherapy response
  • Used when the first surgery could not achieve a complete resection
  • Re-staging imaging guides whether second-look surgery is needed
  • Decision made by the multi-disciplinary team, not one surgeon alone

Did you know?

For most children with solid tumours, surgery alone is not enough. Cancer surgery in children almost always works alongside chemotherapy — and sometimes radiation. The sequence matters: chemotherapy given before surgery can shrink a tumour significantly, turning an operation that might have been complex or incomplete into one that achieves a full, clean removal. The treating team’s role is to find the right combination and order of treatments for your child’s specific tumour — not to follow a fixed script. Source: Children’s Oncology Group (COG) treatment guidelines

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Meet the Specialists

17+ senior cancer specialists. One panel for your case.

Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.

Dr. Naresh Gundu
Medical Oncologist

Dr. Naresh Gundu

MBBS, DNB (Internal Medicine), DM (Medical Oncology)

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Dr. C. Raghavendra Reddy
Medical Oncologist

Dr. C. Raghavendra Reddy

MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)

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Dr. Bharati Devi Gorantla
Medical Oncologist

Dr. Bharati Devi Gorantla

MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)

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Dr. Owais Mohammed
Medical Oncologist

Dr. Owais Mohammed

MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)

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Dr. T. Raghavender Reddy
Medical Oncologist

Dr. T. Raghavender Reddy

MBBS, DM (Medical Oncology), MD (Radiation Oncology)

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Dr. N. Kiranmayee
Medical Oncologist

Dr. N. Kiranmayee

MBBS, DM (Medical Oncology), MD (Internal Medicine)

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Dr. Muralidhar Muddusetty
Surgical Oncologist

Dr. Muralidhar Muddusetty

MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)

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Dr. Raghavendra Naik
Surgical Oncologist

Dr. Raghavendra Naik

MBBS, MS (General Surgery), M.Ch (Surgical Oncology)

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Dr. Mohammed  Imaduddin
Surgical Oncologist

Dr. Mohammed Imaduddin

M.B.B.S, MS (General Surgery), M.Ch (Surgical Oncology)

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Dr. Vinay Mamidala
Surgical Oncologist

Dr. Vinay Mamidala

MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)

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Dr. Paila Gowri Naidu
Surgical Oncologist

Dr. Paila Gowri Naidu

MBBS, MS (General Surgery), M.Ch (Surgical Oncology), FMAS

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Dr. Venkata Sushma P
Radiation Oncologist

Dr. Venkata Sushma P

MBBS, MD (Radiation Oncology)

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Dr. Kirti Ranjan Mohanty
Radiation Oncologist

Dr. Kirti Ranjan Mohanty

MBBS, MD (Radiation Oncology)

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Dr. Gangadhar Vajrala
Radiation Oncologist

Dr. Gangadhar Vajrala

MBBS, MD (Radiation Oncology), MPH

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Dr. Basudev Pokhrel
Hematologist

Dr. Basudev Pokhrel

MBBS, M.D (Immunohematology & Blood Transfusion)

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Dr. Mohammed Imran
Interventional Radiologist

Dr. Mohammed Imran

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Dr. Vajja Sandeep Kumar
Surgical Oncologist

Dr. Vajja Sandeep Kumar

MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology

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Dr. Sridhar Kamani
Surgical Oncologist

Dr. Sridhar Kamani

MBBS, MS (General Surgery), DrNB (Surgical Oncology)

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From Diagnosis to Recovery

How child cancer surgery is planned and delivered — step by step

No child walks into an operating theatre without weeks of careful planning. Here is what the surgical journey looks like in a well-coordinated paediatric oncology centre, so you know what to expect at every stage.

Tissue diagnosis first — biopsy before surgery planning

Before any major surgery can be planned, the team needs to know exactly what type of cancer is present and, increasingly, its molecular characteristics. A biopsy is performed to obtain a tumour tissue sample. This result drives every subsequent decision — including which chemotherapy is used, whether surgery comes first or after chemotherapy, and what type of reconstruction is needed. In bone tumours, the biopsy must be planned by the same surgeon who will later perform the definitive resection, because the biopsy track must be removed during the main operation.

Tumour board review — the whole team plans together

Once the biopsy result, imaging studies (MRI, CT, or PET-CT), and any molecular test results are available, the case is presented at a multi-disciplinary tumour board. This brings together the paediatric oncologist, surgical oncologist, radiation oncologist, pathologist, and radiologist in one room to agree on the treatment plan before anything begins. This step ensures that your child’s surgery is planned in the context of the full treatment strategy — not as an isolated procedure. CION runs tumour board discussions for every new case.

Pre-operative chemotherapy (neoadjuvant) when indicated

For many childhood solid tumours — including Wilms tumour, neuroblastoma, rhabdomyosarcoma, osteosarcoma, and Ewing sarcoma — chemotherapy is given before surgery. This shrinks the tumour, makes it easier to remove completely, can convert an inoperable tumour to an operable one, and gives the team information about how sensitive the tumour is to treatment. The tumour response to neoadjuvant chemotherapy is assessed with repeat imaging before the surgical date is set.

Surgical planning — imaging, margins, and reconstruction

Before the operation, the surgeon reviews the most recent imaging in detail to plan exactly how to approach the tumour, how to achieve clear margins, and — in the case of bone tumours or organ resections — how to reconstruct what is removed. For limb tumours, this includes selecting the correct size and type of implant. For kidney or liver tumours, it involves mapping precisely how much healthy tissue will remain after the tumour is removed. The surgical team discusses anaesthesia requirements, blood management, and the postoperative plan with the nursing and intensive care teams.

The operation — what happens on the day

Your child will be prepared by the anaesthesia team; for most major paediatric cancer operations this involves a general anaesthetic. The surgical team removes the tumour and any involved tissue, aiming always for a clear margin confirmed during the procedure. In limb-sparing surgery, reconstruction of the bone and joint follows tumour removal in the same operation. The specimen is sent immediately to the pathologist, who may provide a preliminary assessment of the margin while the child is still in the operating theatre. The operation duration depends on the tumour type, location, and reconstruction complexity — the team will tell you the expected duration before the day.

Pathology result — confirming the surgical margin

After the operation, the removed specimen is examined thoroughly by the pathologist. The critical question is whether the tumour was removed with a clear margin — meaning no cancer cells are present at the edge of the specimen. The pathology report also assesses how well the tumour responded to pre-operative chemotherapy, which guides the post-operative treatment plan. The surgical team will share the pathology result with you in a clinic appointment and explain what it means for your child’s next steps.

Post-operative chemotherapy and rehabilitation

Surgery in childhood cancer is rarely the end of treatment. Post-operative (adjuvant) chemotherapy continues after the child has recovered sufficiently from the operation — typically within two to four weeks, depending on wound healing and the child’s blood counts. In parallel, physiotherapy begins early for children who have had limb reconstruction, to restore strength, movement, and confidence. For abdominal operations, nutrition support and gradual return to eating are managed by the nursing and dietitian team. Emotional support for both the child and the family is part of CION’s care throughout this period.

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Did you know?

If your child has been diagnosed with a bone tumour, there is a dedicated page explaining limb-sparing surgery and prosthesis options in much more detail — including expandable implants, how rehabilitation works, and what to expect during the growth years after surgery. For a broader overview of how childhood cancer is managed from diagnosis to recovery, visit our childhood cancer treatment overview page. You can also explore the full pediatric cancer hub for information on specific cancer types.

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Common questions

Your questions about surgery for childhood cancer — answered

Does my child definitely need surgery for cancer?
Not every child with cancer needs surgery. Whether surgery is recommended depends on the type of cancer, where it is in the body, its size, and how it has responded to other treatments such as chemotherapy. Blood cancers — such as leukaemia and most lymphomas — are not treated with surgery; they are managed with chemotherapy and sometimes bone marrow transplant. Solid tumours — such as Wilms tumour, neuroblastoma, osteosarcoma, rhabdomyosarcoma, and liver tumours — usually involve surgery as part of the treatment plan, either as the first step or after shrinking the tumour with chemotherapy first. Your child’s team will explain the specific role surgery plays in your child’s treatment plan, and nothing will proceed without your informed understanding and written consent.
What does "limb-sparing surgery" mean, and when is it possible in children?
Limb-sparing surgery (also called limb-salvage surgery) means removing a bone or soft-tissue tumour from a child’s arm or leg while keeping the limb intact, rather than amputating. The tumour is removed with a clear margin of surrounding healthy tissue, and the missing bone is replaced with a metal implant (endoprosthesis), a bone graft, or a combination of both. In growing children, expandable implants can be used that can be lengthened as the child grows. Limb-sparing surgery is now the standard approach for most children with bone sarcomas (osteosarcoma, Ewing sarcoma) in the limbs when the tumour can be fully and safely removed. It is only recommended when the surgeon is confident that a clear margin is achievable and that the preserved limb will be functional. Whether it is suitable for your child depends on the tumour location, its relationship to blood vessels and nerves, and how well it has responded to pre-operative chemotherapy.
What is organ-sparing surgery in childhood cancer?
Organ-sparing surgery means removing a tumour while preserving as much of the affected organ as possible, rather than removing the entire organ. In children, this principle is applied in several cancers. In kidney tumours such as Wilms tumour, a “nephron-sparing” or partial nephrectomy removes the tumour while keeping the healthy part of the kidney — important because children need their kidneys for a lifetime. In eye tumours such as retinoblastoma, eye-sparing approaches using targeted treatments aim to avoid removal of the eyeball when safe to do so. In liver tumours such as hepatoblastoma, partial liver resection removes the tumour while preserving enough liver tissue to maintain function. The feasibility of organ-sparing surgery depends on the tumour size, position, and response to pre-operative chemotherapy — your child’s team will explain whether it is an option for your child.
Is cancer surgery safe for children? What are the main risks?
Cancer surgery in children carries the same general surgical risks as any major operation — anaesthesia, bleeding, infection, and wound healing — but in paediatric oncology these are managed by teams experienced specifically in operating on children with cancer. Children often tolerate surgery well when it is planned carefully as part of a multi-disciplinary treatment plan. The most important factor in reducing risk is having surgery at a centre where surgeons have experience with the specific tumour type and where the whole team — paediatric surgeons, anaesthetists, intensivists, and nursing staff — work together. Tumour-specific risks depend on the tumour’s location: a kidney tumour carries different risks from a liver tumour or a bone tumour. Your surgical team will discuss the risks specific to your child’s operation before you consent to proceed.
Why is surgery sometimes done before and sometimes after chemotherapy in children?
The sequence of surgery and chemotherapy depends on the type of tumour and what the treating team believes will give the best outcome. In some cancers — such as Wilms tumour (kidney), neuroblastoma, and rhabdomyosarcoma — chemotherapy is given first to shrink the tumour and make surgery safer and easier (this is called neoadjuvant or pre-operative chemotherapy). A smaller tumour is easier to remove completely, reduces the risk of surgical complications, and can sometimes make organ-sparing surgery possible when the original tumour was too large. In other situations — such as some liver tumours or well-localised solid tumours — surgery is performed first, followed by chemotherapy to eliminate any remaining cancer cells. Your child’s team will explain the reasoning for the sequence they are recommending for your child, and the sequence forms part of the written treatment plan you receive before starting.
How long will my child be in hospital after cancer surgery?
Hospital stay after cancer surgery in children varies depending on the type and size of the operation. A smaller procedure such as a biopsy or port placement typically requires one day or a brief overnight stay. More complex operations — such as a kidney tumour removal, a liver resection, or a bone tumour reconstruction — usually require a hospital stay of several days to one to two weeks, depending on how quickly the child recovers, whether drains or monitors need to be in place, and how soon they can eat and move around safely. After discharge, children are seen regularly in clinic for wound checks, and post-operative chemotherapy usually begins within a few weeks. CION’s team will give you a clear timeline before surgery so you can plan around it as a family.
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