Shaping the future of liver surgery: Implementation of experimental insights into liver regeneration

Abstract

Background: While 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.

Methods: A review of the literature was carried out.

Results: We 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.

Conclusion: The 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.

Keywords: Hepatic Progenitor Cells; Liver Dysfunction; Postoperative Outcome; Therapeutic Approaches; Von Willebrand Factor.

Fig. 1

Repeated liver resections are possible due to well-functioning liver regeneration. a Computer tomography scan of a patient with recurrence of metastatic disease in the liver after a precedent liver resection. b Still, potentially curative liver resection could be performed, as the patient’s liver fully regenerated in volume and function

Fig. 2

Scheme of research construction in the field of liver regeneration. While basic science is clearly the basis of good research in liver regeneration, as it is vital for identification of potential therapeutic targets, translational research, comprising validation of basic research results and evaluation in the human setting, is of central importance. However, potential interfering factors as well as of potentially adverse effects need to be excluded before an evaluated target can be considered trustworthy for any kind of therapeutic intervention