Mediastinal tumors present significant surgical challenges due to their complex anatomical location and close association with the heart, major blood vessels, and principal neural structures. Surgical resection remains the primary treatment for achieving a cure or long-term disease control. With the advancement of imaging techniques and minimally invasive surgery, operative strategies for mediastinal tumors have evolved from conventional open surgery to a diversified approach that includes open surgery, video-assisted thoracoscopic surgery (VATS), and robot-assisted thoracoscopic surgery (RATS). Each surgical modality varies in terms of operative exposure, technical precision, invasiveness, and perioperative risk. Therefore, the selection of a procedure is influenced by tumor location, size, extent of invasion, and the surgeon's experience, and no standardized strategy has been established yet. Based on mediastinal anatomical compartments, this review summarizes the technical characteristics, indications, and limitations of open surgery, VATS via intercostal and subxiphoid approaches, RATS, and other emerging minimally invasive techniques. Emphasis is placed on surgical selection strategies, aiming to provide a practical reference for the individualized surgical management of mediastinal tumors.