Background <p>Liver tumors in childhood are rare and associated with high treatment demands. Over the past decades substantial progress has been achieved through effective chemotherapies and improved surgical techniques as well as international collaborations. Nevertheless, the challenges for the surgical treatment remain high. In Germany additional specific difficulties arise in this context.</p> Objective <p>To summarize the current evidence on the surgical management of pediatric liver tumors, to analyze the care structures in Germany and to develop perspectives for optimizing treatment.</p> Material and methods <p>Narrative review of the current evidence, systematic analysis of the surgical results of previous hepatoblastoma studies, and evaluation of German care pathways in order to identify problems and perspectives.</p> Results <p>The improved prognosis of children with liver tumors (particularly hepatoblastoma) is mainly due to multimodal, risk-adapted treatment concepts and advances in surgical strategies. Because of the rarity of pediatric liver resections, pediatric liver tumor surgery in Germany is positioned at the intersection of pediatric, visceral and transplantation surgery. Surgically, strategies adapted to children are crucial to increase resection rates and avoid postoperative complications. A direct transfer of concepts from adult liver surgery carries substantial risks. In Germany the basic prerequisites are good but care can be further improved through better communication with reference structures, intelligent centralization approaches and investment in surgical training.</p> Discussion <p>Pediatric liver tumor surgery is associated with specific challenges due to the rarity and high demands. In Germany, strengthening multidisciplinary structures and communication as well as efficient centralization of treatment planning, can further improve patient safety and outcomes for children with liver tumors.</p>