Optimizing preoperative portal vein embolization for liver resection

The unique capacity of the liver to regenerate has been a topic of interest for many of researchers. The exact mechanisms still remain unclear. In the field of liver surgery, a future remnant liver volume of at least 25% of the total liver volume is necessary to prevent postoperative liver failure. A well-established method to enhance both liver volume and liver function preoperatively, is portal vein embolization (PVE). With PVE, a compensatory regeneration response of the non-embolized liver lobe is induced, resulting in increased volume and function of the future remnant liver, which contributes to performing safer resection. The search for an absorbable embolization material in rabbits for PVE to prevent complications that can occur due to the use of permanent embolization is presented in this thesis. This thesis also focuses on 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) as a quantitative liver function test which can be used to predict the hypertrophy response 3 weeks after PVE. Bile acids have been identified to play an important role in the early phase of liver regeneration by activating bile salt-activated transcription factor farnesoid X-receptor (FXR). We evaluated the effect of a potent FXR agonist (obeticholic acid, OCA) on liver growth following portal vein embolization in a rabbit model. This thesis explores several conditions of preoperative liver augmenting procedures along with aspects of perioperative care in patients undergoing major liver resection in order to improve postoperative outcomes in terms of postoperative morbidity and mortality.