The working group of the Department of Ingrassia in its various scientific components (Hygiene and General and Applied, Pathological Anatomy, Anatomy, General Surgery) has preliminarily examined the epidemiological data of hepatocarcinoma in Sicily where in the two thousand years the infection with hepatitis C virus, and to a lesser extent B (for the effects of vaccination since 1978) has been a fundamental etiological factor in the onset of hepatocarcinoma.
This tumor that, in 2020, predicted about 500 cases per year (3.8% of all neoplasms in Sicily) with a mortality in line with the other regions of Southern Italy (22.5 x 100 thousand deaths in males - 8.8 x 100 thousand deaths in females) higher than the other regions of Central-Northern Italy, and an average 5-year survival of 20%.
Considering the relationship between infection and cancer sufficiently studied, the working group considered another important and frequent risk factor such as obesity. In 2019 in Sicily there were in fact 800 thousand obese and 2.3 million overweight subjects (47% of the resident population) who often have associated cardio-pulmonary diseases and greater risk of the onset of neoplasms. The possibility of the onset of a hepatocarcinoma is based on the data well reported in the literature.
The obese patient is in fact in most cases a carrier of NAFLD (non-alcoholic fatty liver disease) or hepatic steatosis which, over time, evolves towards steatohepatitis (NASH) characterized by the appearance of an important component of fibrosis within the hepatic parenchyma that preludes to an unbalanced fibrosis / parenchyma characteristic damage of liver cirrhosis, the first and most important risk factor of hepatocarcinoma.
In consideration of the specific skills, the working group and based on an in-depth review of the data in the scientific literature that underline the benefits of bariatric surgery not only on weight loss but also on changes in the intestinal microbiome and its positive influence on the progression of steatosis, as well as a negative correlation with HP infection.
The following activities were carried out: