Abstract
SummaryBackgroundWhile liver surgery has become a safe and feasible operation technique, the incidence of postoperative liver dysfunction still remains a central problem. Approximately 10% of patients undergoing liver resection were shown to develop liver dysfunction, which is associated with an increased risk of morbidity and mortality. Yet, to date there is no effective treatment option for postoperative liver dysfunction available. The development of postoperative liver dysfunction was linked to a disruption in the liver’s potential to regenerate. Thus, it is importance to elucidate the underlying mechanisms of liver regeneration and to find potential therapeutic targets for the treatment of patients with postoperative liver dysfunction.MethodsA review of the literature was carried out.ResultsWe report on potential future interventions for improvement of liver regeneration after surgical resection. Moreover, we evaluate the benefits and drawbacks of hepatic progenitor cell therapy and hematopoietic stem cell therapy. However, the most significant improvement seems to come from molecular targets. Indeed, von Willebrand factor and its pharmacologic manipulation are among the most promising therapeutic targets to date. Furthermore, using the example of platelet-based therapy, we stress the potentially adverse effects of treatments for postoperative liver dysfunction.ConclusionThe present review reports on the newest advances in the field of regenerative science, but also underlines the need for more research in the field of postoperative liver regeneration, especially in regard to translational studies.
Highlights
Today, liver resection represents a safe and feasible therapeutic option for the treatment of malignant and benign liver tumors [1, 2]
We aim to present an overview of the most promising experimental data regarding potential therapeutic targets to support liver regeneration in patients suffering from postoperative liver dysfunction (LD)
While a large clinical study showed that patients with high preoperative levels of von Willebrand factor antigen (vWF-Ag) had a significantly increased risk for development of postoperative LD, complications, and even mortality, we aimed to provide more insight into the pathophysiological involvement of vWF-Ag in liver regeneration
Summary
Liver resection represents a safe and feasible therapeutic option for the treatment of malignant and benign liver tumors [1, 2] This is due to a continuous refinement of surgical strategies, starting from a simple left lobe resection in 1888 and evolving into an adjustable procedure with a high degree of personalization to the patients’ needs [3]. The former limitations of liver surgery, namely, bleeding at the site of resection, bilobar tumor growth, and multiple metastasis within the liver, could be overcome, which makes major resection of up to 75% of the livers initial volume a feasible and safe operation [4, 5]. This technique allows for major resection in patients with an initial future liver remnant of less than 25%, as it triggers regeneration in the healthy liver parenchyma
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