Major intraoperative complications are a known and dreaded possibility in pediatric surgical oncology. Several pediatric tumors encase major neurovascular structures in ways that create significant surgical risk. Other major complications may carry less immediate life-threatening risk, but still threaten significant long-term morbidity. The relatively good long-term outcomes for pediatric solid tumors, coupled with the ability of children to tolerate major surgery with significant pathophysiologic disruption, and the reluctance to “give up” on pediatric patients all contribute to efforts toward heroic surgical procedures with their associated major risks.