Enhancement of liver regeneration and liver surgery

Liver regeneration allows surgical resection of up to 75% of the liver and enables curative treatment potential for patients with primary or secondary hepatic malignancies. Liver surgery is associated with substantial risks, reflected by considerable morbidity and mortality rates. Optimization of several aspects in liver resection could enhance the outcomes for patients who require liver surgery. Reduction of intra-operative ischemia could improve liver function and preserve the regenerative capacity. In addition, preoperative optimization using portal vein embolization could reduce morbidity and mortality, but selection of patients for embolization remains difficult. Modulation of the bile acid farnesoid X Receptor (FXR) could be a promising alternative to stimulate lever regeneration. Also, new surgical techniques such as associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) have emerged to overcome some of these limitations, however, not without controversy. The thesis aimed to enhance liver regeneration and liver surgery by using both experimental and clinical approaches.