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10.1245/ASO.2003.11.010
Annals of Surgical Oncology 10:801-809 (2003)
© 2003 Society of Surgical Oncology
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ORIGINAL ARTICLES

Decreased Expression of Stem Cell Factor in Esophageal and Gastric Mucosa After Esophagogastric Anastomosis for Cancer: Potential Relevance to Motility

Mario Nano, MD, FACS, Edda Battaglia, MD, Guido Gasparri, MD, FACS, Luca Dughera, MD, Pier Agostino Casalegno, MD, Graziella Bellone, PhD, Daniela Tibaudi, MD, Claudia Gramigni, PhD, Marco Ferronato, MD, Luigi Chiusa, MD, Monica Navino, MD, Mario Solej, MD, Marcello Dei Poli, MD and Giorgio Emanuelli, MD

From the General Surgery Section (MN, GG, MF, MS, MDP) and Internal Medicine Section (GB, DT, CG, MN, GE), Department of Clinical Physiopathology, S. Giovanni Battista Hospital of Torino (EB, LD, PAC); and Department of Biomedical Sciences and Human Oncology (LC), University of Torino, Torino, Italy.

Correspondence: Address correspondence and reprint requests to: Mario Nano, MD, FACS, Department of Clinical Physiopathology, University of Torino, Via Genova 3, 10126 Torino, Italy; Fax: 39-011-696-0170; E-mail: mario.nano{at}unito.it

Background: Esophageal replacement with gastric tube is a well-established reconstruction of the alimentary tract after esophagectomy in cancer patients. The resulting molecular events in the transposed gastric tube and residual esophagus have yet to be investigated. Stem cell factor (SCF) was recently shown to be critical for signaling in gastrointestinal motility. SCF expression is here correlated with changes in mucosal morphology, acid and biliary reflux, and motility in the residual esophagus and gastric tube.

Methods: Thirteen patients surgically resected for squamous esophageal carcinoma with gastric tube replaced by esophagogastric anastomosis underwent upper endoscopy, esophageal manometry, 24-hour pH monitoring, and bile reflux detection. Esophageal and gastric mucosa samples were examined for SCF expression by immunohistochemical and semiquantitative reverse transcriptase-polymerase chain reaction analysis and for SCF serum levels by enzyme-linked immunosorbent assay.

Results: All patients showed severe residual esophagus hypoperistalsis and no gastric tube motor activity. The 24-hour pH monitoring was positive in most; 24-hour bile detection was mostly negative. SCF levels in the residual esophageal and gastric tube mucosa were dramatically decreased compared with those of normal subjects. The correlation between SCF and slow-wave activity was positive.

Conclusions: Hypomotility of the residual esophagus and gastric tube seems closely associated with disruption of the SCF/c-kit signaling pathway. However, the absence of notable relations between mucosal changes after chronic exposure to acid, biliary gastric content, and SCF expression indicates that this analysis cannot be considered part of endoscopic follow-up.

Key Words: Esophagogastric anastomosis • Stem cell factor • Motility • c-kit • Interstitial cells of Cajal






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