Mils for HCC: the state of art

After an initial skepticism, minimally invasive liver surgery (MILS) gained popularity and is nowadays a consolidated option in specialized centers for the surgical treatment of selected patients affected by both benign and malignant liver diseases. Nevertheless, the role of MILS in the surgical treatment of hepato-cellular carcinoma (HCC) developed on the background of chronic liver disease is still a matter of debate. The indications and the current evidences on MILS for HCC are discussed in this paper. MILS being less invasive and harmful for the patients proved to offer a reduction in post-operative morbidity and specific benefits have been highlighted in case of patients affected by HCC and chronic liver disease. In fact, by minimizing liver manipulation and mobilization and by preserving the collateral blood and lymphatic flow, MILS seems to reduce the incidence of post-operative ascites and post-operative liver failure without compromising the oncologic outcomes. This has been confirmed by an analysis of 21 comparative studies and 5 metanalyses comparing MILS and open surgery for HCC. With an adequate surgical training, MILS for HCC can be undertaken safely even in case of major hepatectomies and technically demanding operations such as resections of posteriorly located tumors proved to be feasible in specialized centers. Therefore, with an appropriate patients' selection, MILS for HCC is becoming the preferred option for the surgical treatment of HCC in cirrhotic patients.