Surgical management of childhood cancers in developing countries must be adapted to available resources and local disease phenotype. The International Society of Paediatric Oncology (SIOP) outlines minimal requirements for centers treating childhood cancers with curative intent, both in terms of equipment and expertise, which is termed “setting 1”. Centers that do not meet this minimal requirement, so-called “setting 0”, should focus on a palliative approach as the lack of supporting facilities would result in increased suffering if active treatment was attempted. Common pediatric cancers, including Wilms tumor, neuroblastoma, teratoma, and retinoblastoma, often present differently in LMICs, warranting an alternative treatment approach. Aggressive treatment must be balanced with the risk of treatment-related morbidity and mortality in settings with low resources for supportive facilities. Additionally, late presentation of childhood cancers is more common in low-resource settings, leading to an overall higher disease stage and increased risk of complications such as tumor rupture.