Surgical intervention plays a major part in the management of many pediatric cancer patients. The particular role it plays varies with the diagnosis and location of the disease. The goals of surgical intervention also vary in patients within the early stages, advanced stages, and patients with recurrent disease. The aims of surgical intervention in pediatric cancer can generally be divided into, but not exclusive to, the following: The principles of these interventions are discussed in this chapter. In some cases where advanced disease makes a cure impossible, surgery can still have a role in palliation when symptoms cause severe symptoms or suffering. The proposed site of surgery of palliation can be either at the primary site, distant metastases, or symptoms associated with disturbed physiology or function. One indication for palliative surgical intervention can be drainage of malignant effusions. Abnormally large accumulation of fluid in body cavities can occur in patients with cancer. These can give rise to disfiguring symptoms, compressive symptoms, or physiological effects, thereby requiring intervention. Drainage can either be on-off (i.e., aspiration) or continuous (placement of a drainage tube) or a surgical procedure to prevent or divert the accumulation. The two main body cavities (thorax and abdomen) can be affected by malignant fluid collections and are also discussed here.