During the past few decades, an impressive improvement in the survival outcome of children with malignant solid tumors has been achieved. The adoption of multimodal therapy including surgery, chemotherapy, and radiotherapy has played a crucial role in this achievement. The introduction of systemic chemotherapy in the 1970s has led to preoperative tumor downstaging in the majority of pediatric solid neoplasms, especially Wilms’ tumor, hepatoblastoma, neuroblastoma, and malignant germ cell tumors. The effective use of neoadjuvant chemotherapy facilitated complete tumor resection with negative margins, and reduced intraoperative complications, especially tumor rupture and spillage that previously led to upstaging and poor outcomes. This has contributed to improving the overall survival in these pediatric solid tumors from a dismal 30–80% or higher. Adjuvant chemotherapy is imperative in the majority of cases as per their risk stratification, and in selected patients with appropriate tumor diagnosis and biology who have microscopic positive margins, it can obviate the need for second-look surgery and associated further morbidity.