Abdominal approach is commonly used for resection of liver tumors.However, in rare cases,transthoracic approach may be a valuable option for management of lesions located in the hepatic dome or involving the cavo-hepatic junction for very selected patients.This approach can be an open procedure (thoracotomomy), a videoassisted minimally invasive technique (thoracoscopy), or a strictly percutaneously treatment (CT-guided radiofrequency ablation).This approach seems useful for high-risk patients, with previous major abdominal surgery, or awaiting for liver transplantation (bridge concept) with cranially located single lesions.A limited liver resection (tumorectomy or segmentectomy) can be performed, but this approach is also suitable for percutaneous ablation therapy (radiofrequency or cryotherapy), with an acceptable morbidity.KEY POINTS · The thoracic route is particularly interesting in selected patients with an isolated lesion of the hepatic dome.· The thoracic route is simply another surgical approach: neither the therapeutic indications nor the margins should be modified.· The thoracic route presents clear advantages in the patient with multiple upper abdominal surgeries and/or in patients with HCC awaiting hepatic transplantation.· The trans-diaphragmatic route allows only restricted hepatic resections.· The thoracic route is well suited to radiofrequency or cryotherapy ablation therapy.· The specific thoracic morbidity is acceptable.