Surgical Management of Metastatic Pediatric Solid Tumors: Histology-specific Strategies and Multidisciplinary Approaches.

Metastatic pediatric solid tumors require tailored surgical approaches guided by tumor histology, treatment response, and multidisciplinary collaboration. This article reviews current strategies for surgical management of metastases across common pediatric cancers, including osteosarcoma, Ewing sarcoma, Wilms tumor, rhabdomyosarcoma, hepatoblastoma, and nonrhabdomyosarcoma soft tissue sarcomas. Emphasis is placed on indications for metastasectomy and the integration of surgery with systemic therapies. Special considerations for extrapulmonary metastases including liver, lymph node, bone, and brain involvement are also addressed. The article underscores the importance of multidisciplinary care to balance aggressive tumor control with preservation of long-term function and reduction of late treatment-related morbidity.