WWP2 and its association with PTEN in endometrial cancer.

We wished to determine if WWP2 gene expression and PTEN protein levels inversely correlate in human endometrial cancer tissues. Fifty-one endometrioid endometrial tumors and five normal endometrial controls were available for analysis. PTEN protein levels were assessed by immunohistochemistry (IHC). WWP2 and PTEN gene expression were quantitated by RT PCR. Clinical and pathologic information was collected by chart review. We found that in tumors with low PTEN protein but normal mRNA expression there were significantly higher levels of WWP2 expression (p = 0.0017). Increased WWP2 expression was not associated with clinical prognostic factors including lymphovascular space invasion, ≥ 50% myometrial invasion, grade, stage or recurrence. WWP2 expression was not different statistically between tumors and normal controls (p = NS). Therefore, in this cohort, tumors with low PTEN protein but normal mRNA expression had elevated levels of WWP2 expression. This suggests that WWP2 may be playing a role in PTEN degradation in endometrial cancer.

Predicting inpatient stay lasting 2 midnights or longer after robotic surgery for endometrial cancer.

OBJECTIVE: To estimate the rate of inpatient stay and the factors predicting inpatient status after robotic surgery for endometrial cancer following the change in the Medicare definition of "inpatient" to include hospitalization spanning 2 midnights. DESIGN: Retrospective chart review (Canadian Task Force classification II-1). SETTING: Academic hospital. PATIENTS: All patients (n = 395) with endometrial cancer who underwent robotic surgical management between 2006 and 2010. INTERVENTION: The outpatient stay group with hospitalization spanning 1 midnight was compared with the inpatient stay group with hospitalization spanning 2 midnights or longer through estimation of the adjusted relative risk (aRR) for various characteristics of interest. RESULTS: Ninety-six of 395 patients (24.3%) stayed at least 2 midnights and thus were deemed inpatients. Clinical factors associated with inpatient stay were increasing age, history of myocardial infarction (aRR, 2.0; 95% confidence interval [CI], 1.0-3.7), surgery start time at or after 12 noon (aRR, 1.7; 95% CI, 1.2-2.4), perioperative blood transfusion (aRR, 3.2; 95% CI, 2.3-4.5), and surgery performed in the year 2010 (aRR, 0.5; 95% CI, 0.3-0.7). Age ≥ 60 years was associated with at least a 2-fold adjusted risk of prolonged hospitalization. Body mass index, other medical comorbidities, operative duration, estimated blood loss, and performance of lymphadenectomy or additional surgical procedures were not identified as significant risk factors. CONCLUSION: Approximately 75% of the patients undergoing robotic surgery for endometrial cancer were discharged as outpatients. Recognition of factors predicting inpatient stay can improve hospital resource allocation and throughput in women undergoing robotic surgery for endometrial cancer.

Reducing readmissions after robotic surgical management of endometrial cancer: a potential for improved quality care.

OBJECTIVE: To describe readmission patterns after robotic surgery for endometrial cancer and identify risk factors for readmission within 90 days of discharge. METHODS: Patients with endometrial cancer who underwent robotic surgical management at an academic institution from 2006 to 2010 were identified. Patient characteristics, intraoperative data, and postoperative complications were analyzed. Student's t-test and Fisher's exact test were used to compare patients readmitted within 90 days to those who were not. RESULTS: Three hundred ninety-five patients were included. Thirty (7.6%) were readmitted within 90 days of surgical discharge. Length of stay greater than one day (40.0% vs. 23.0%, p=0.04) and postoperative complication (63.3% vs. 13.4%, p<0.01) were associated with readmission. The median interval to readmission was 9.5 days and median duration of subsequent hospitalization was 2.5 days. Fever (31.3%) and workup for vaginal drainage (25.0%) were the most common reasons for readmission. Only 2 of the 10 patients readmitted with fever had culture-proven infection, and no patients readmitted for vaginal drainage had a confirmed urinary tract injury. Of the 30 patients readmitted, 5 required a second operation - 3 for vaginal cuff dehiscence and 2 for port site hernia. CONCLUSIONS: Robotic surgery for endometrial cancer was associated with a 7.6% readmission rate. The most common reasons for readmission, fever and evaluation for urinary tract injury, were frequently not associated with severe illness. This supports additional education to consider raising the threshold for readmission by using more widespread outpatient evaluation for the potential complications of robotic endometrial cancer surgery.

Prevalence and patient characteristics associated with CIN 3 in adolescents.

OBJECTIVE: We sought to identify patient characteristics associated with cervical intraepithelial neoplasia (CIN) 3 in adolescents. STUDY DESIGN: A cross-sectional cohort study was done using a colposcopic database. Data collected included demographic and clinical information as well as cytologic and histologic results. Variables associated with CIN 3 in the univariable analysis (P ≤ .10) were included in a multivariable logistic regression model. RESULTS: Of 614 adolescents evaluated, 48 (8%; 95% confidence interval, 6-10%) had CIN 3. No cancers were detected. In the univariable analysis, parity, ≥ 4 lifetime male sexual partners, and a history of sexually transmitted infections were associated with an increased risk of CIN 3. In the final model, only ≥ 4 sexual partners (compared to <4; adjusted odds ratio, 3.66; 95% confidence interval, 1.26-10.61) was significantly associated with the finding of CIN 3. CONCLUSION: CIN 3 was infrequently encountered in adolescents, and those with multiple sexual partners were at increased risk for CIN 3.