Concurrent Medical Comorbidities Research Articles

Abstract B008: Survival outcomes in older people living with HIV and cancer

Abstract The success of antiretroviral therapy (ART) has led to an aging of the population of people with HIV (PWH). In the United States, over 50% of the 1.3 million PWH are currently over the age of 50. Studies have shown that PWH have advanced biological age as compared to the general population. Little is known about HIV and cancer characteristics in older PWH and the impact of these conditions on survival outcomes in this population. To evaluate this we conducted a retrospective review of PWH over the age of 60 years with cancer at the HIV and AIDS Malignancy Branch at the National Cancer Institute (NCI) from March 2001 to December 2021. We evaluated characteristics by age of intial cancer diagnosis (<60 years vs. >60 years) to determine the proportion of older PWH with a prior cancer diagnosis over their lifespan. We collected patient demographics, cancer and HIV characteristics, and other medical comorbidities. We calculated overall survival of patients from the age of 60 to last follow-up/death by Kaplan-Meier method and stratified by age at initial cancer diagnosis. We identified 32 patients (29 cisgender male, 3 cisgender female) who were seen in our clinic at the age of 60 years or older. 18 (56%) patients were diagnosed with cancer < 60 years and 14 (44%) were diagnosed > 60 years. 25 (78%) patients were non-Hispanic White and 7 (22%) were non-Hispanic Black. Kaposi sarcoma (20, 62%) was the most common cancer and cardiovascular disease (18, 56%) was the most common medical comorbidity in both age groups. Of the patients with cancer < 60 years, 12 (67%) were diagnosed with 1 cancer, and 6 (33%) had two or more cancer diagnoses. Of the patients diagnosed with cancer aged > 60 years, 8 (57%) were diagnosed with 1 cancer, and 6 (43%) were diagnosed with 2 or more cancers. Although patients diagnosed with cancer after 60 years presented with more comorbidities than patients diagnosed with cancer before 60, this was not significant (P= 0.72). HIV was well-controlled in all patients (median: 0 copies/mL, range: 0-216). The median CD4+ T cell count at age of cancer diagnosis was 420 cells/µl (range: 21-950) in those diagnosed <60 and 196 cells/µl (range: 20-682) diagnosed >60, which was not a significant difference (P= 0.54). All patients received cancer-directed therapy for their conditions. Of all patients 60 years and over who were evaluated, 12 patients (36%) died during follow-up, 10 of whom died of cancer. Of those who died during follow-up, 5 (26%) were diagnosed with cancer before 60 while 7 (50%) were diagnosed with cancer after age 60. Among all patients, the median overall survival was 6.8 years with a 5-year survival of 63%. There was no survival difference among those who were diagnosed with cancer before or after age 60 (P=0.10). As life expectancy improves among PWH, patients aged 60 years and over can experience one or more cancer diagnoses. Cancer care in this population requires a multidisciplinary approach that accounts for concurrent medical comorbidities that can impact the treatment course and survival outcomes. Citation Format: Tishiya Carey, Ralph Mangusan, Anaida Widell, Irene Ekwede, Kathyrn Lurain, Ramya Ramaswami. Survival outcomes in older people living with HIV and cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B008.

Role of Transcarotid Artery Revascularization (TCAR) as a Carotid Revascularization Option

Transcarotid artery revascularization (TCAR) is a hybrid carotid revascularization procedure in which carotid stenting is accomplished by making an incision at the base of the neck & surgically exposing the common carotid artery. The evidence base for TCAR safety & efficacy comes from PROOF, ROADSTER, & ROADSTER 2 studies. The Society for Vascular Surgery guidelines for the treatment of carotid artery disease (2022) opine TCAR to be at least equivalent to Carotid Endarterectomy (CEA) in terms of safety & efficacy, with some potential improvements. In comparison with Transfemoral Carotid Artery Stenting (TF-CAS), the overall data demonstrates better outcomes with TCAR. In high-risk subjects like elderly more symptomatic patients with higher concurrent medical comorbidities, TCAR in fact appears to be preferable to both CEA & TF-CAS. Whereas this technique appears safe in the short-term, long-term vessel patency requires prospective follow-up studies.

Development and therapeutic manipulation of the head and neck cancer tumor environment to improve clinical outcomes.

The clinical response to cancer therapies involves the complex interplay between the systemic, tumoral, and stromal immune response as well as the direct impact of treatments on cancer cells. Each individual's immunological and cancer histories are different, and their carcinogen exposures may differ. This means that even though two patients with oral tumors may carry an identical mutation in TP53, they are likely to have different pre-existing immune responses to their tumors. These differences may arise due to their distinct accessory mutations, genetic backgrounds, and may relate to clinical factors including previous chemotherapy exposure and concurrent medical comorbidities. In isolation, their cancer cells may respond similarly to cancer therapy, but due to their baseline variability in pre-existing immune responses, patients can have different responses to identical therapies. In this review we discuss how the immune environment of tumors develops, the critical immune cell populations in advanced cancers, and how immune interventions can manipulate the immune environment of patients with pre-malignancies or advanced cancers to improve therapeutic outcomes.

Incidence and Management of Candida Auris in a Skilled Nursing Home

<h3>Background</h3> Candida auris is an emerging multidrug resistant fungal infection that causes nosocomial transmission. <h3>Methods</h3> We describe the incidence and management of C. auris in a hospital-based skilled nursing facility (SNF). Data on resident demography, concurrent medical comorbidities, and medical interventions were obtained through medical records review. <h3>Results</h3> Nineteen residents were identified with C. auris in the SNF. Seventeen (89%) were admitted from hospitals and other SNFs. Two (10%) were identified with C. auris colonization after a point prevalence screening done by the New York State Department of Health (NYSDOH). Infection control and prevention measures were instituted, including isolation precautions, environmental cleaning and disinfection, and education. Among nineteen residents, six (31%) were cleared using NYSDOH screening criteria. <h3>Conclusions</h3> Aggressive implementation of infection control measures is key in the control and prevention of transmission of C. auris.

Perioperative considerations in the management of obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is characterised by repetitive compromise of the upper airway, causing impaired ventilation, sleep fragmentation, and daytime functional impairment. It is a heterogeneous condition encompassing different phenotypes. The prevalence of OSA among patients presenting for elective surgery is growing, largely attributable to an increase in age and obesity rates, and most patients remain undiagnosed and untreated at the time of surgery. This condition is an established risk factor for increased perioperative cardiopulmonary morbidity, heightened in the presence of concurrent medical comorbidities. Therefore, it is important to perform preoperative OSA screening and risk stratification - using the STOP-Bang screening questionnaire, nocturnal oximetry, and ambulatory and in-laboratory polysomnography, for example. Postoperative risk assessment is an evolving process that encompasses evaluation of upper airway compromise, ventilatory control instability, and pain-sedation mismatch. Optimal postoperative OSA management comprises continuation of regular positive airway pressure, a multimodal opioid-sparing analgesia strategy to limit respiratory depression, avoidance of supine position, and cautious intravenous fluid administration. Supplemental oxygen does not replace a patient's regular positive airway pressure therapy and should be administered cautiously to avoid risk of hypoventilation and worsening of hypercapnia. Continuous pulse oximetry monitoring with specified targets of peripheral oxygen saturation measured by pulse oximetry is encouraged.

The Use of Vertiflex® Interspinous Spacer Device in Patients With Lumbar Spinal Stenosis and Concurrent Medical Comorbidities.

The use of the Vertiflex® interspinous spacer is a recent minimal invasive procedure useful in the treatment of lumbar spinal stenosis (LSS). It is used mostly by interventional pain physicians who can also perform the minimally invasive lumbar decompression (MILD procedure). Previously when a patient had clinical symptomatic neurogenic claudication (NC) and radiologic findings of lumbar stenosis and had failed conservative treatment, the options were decompressive laminectomy, laminectomy with pedicle fixation at one or more levels or laminotomy combined with interlaminar stabilization (Coflex® implant). These procedures were performed by neurosurgeons and orthopedic spine surgeons. However, the majority of patients with LSS are elderly and have multiple comorbidities that can make open spinal surgery, even when limited to one level, an anesthesia risk as well as vulnerable to the risk associated with hospitalization and recovery after spine surgery. The minimally invasive approaches to interspinous stabilization make it possible to treat localized symptomatic stenosis in a broader group of patients that do not want or cannot, have general anesthesia or extensive lumbar surgery, especially in the prone position. This article examines the use of the Vertiflex® implant in an elderly population with significant comorbidities that underwent successful outpatient implantation at one or two levels. In addition, it serves to familiarize spine surgeons about the possibility of using more minimal approaches to treat LSS.

Factors predicting early mortality after new diagnosis of myelodysplastic syndrome: A population-based study.

Little prospective data regarding factors determining patient outcomes in myelodysplastic syndromes (MDS) are available. To establish features of early mortality in MDS, we compare characteristics of patients dying within 1year of diagnosis with those surviving longer. We prospectively enrolled adults with a new MDS diagnosis in a population-based case-control study. Logistic regression was used to calculate odds ratios and 95% confidence intervals for potential predictors of early mortality. Subgroup analyses were conducted within the following groups: high-/very-high-risk IPSS-R; very-low-/low-/intermediate-risk IPSS-R; treated patients; and supportive care only patients. We observed early mortality in those with abnormal cytogenetics (OR: 3.36, 95% CI: 1.52-7.46), three or greater cytogenetic abnormalities (OR: 3.48, 95% CI: 1.51-7.99), treatment at a community medical center (versus academic) (OR: 2.55, 95% CI: 1.18-5.47), and with 2-3 concurrent medical comorbidities (OR: 2.14, 95% CI: 1.08-4.22). Similarly, in subgroup analyses, abnormal cytogenetics remained the main predictor of early mortality. Complex cytogenetics and prognostic risk category have been associated with early mortality without intervention. Our data confirm these associations in a large, prospectively followed cohort and highlight the significance of cytogenetic abnormalities and complexity regardless of IPSS-R risk categorization or treatment.

Factors Predicting Early Mortality in Newly Diagnosed Myelodysplastic Syndrome (MDS): A Population Based Study

Myelodysplastic syndromes (MDS) are a heterogeneous collection of clonal disorders of hematopoietic stem cells characterized by ineffective hematopoiesis, dysplasia, and risk of progression to secondary acute myeloid leukemia (AML). Despite the development of numerous prognostic scoring systems (MDS Comorbidity Index (MDS-CI),International Prognostic Scoring System (IPSS) and IPSS-R, updated WHO classifications, and WHO prognostic scoring system (WPSS)), little prospective data regarding the influence of these and other factors on patient outcomes is available. To better elucidate the features of early mortality in MDS we compare characteristics of patients dying within one year of MDS diagnosis with those surviving longer in our Adults in Minnesota with MDS (AIMMS) population based case-control study.The AIMMS study is a statewide prospective population-based case-control study (R01 CA142714) conducted by the University of Minnesota (UMN), Mayo Clinic, and the Minnesota Department of Health. Adults (age 20-85 years) with a new diagnosis of MDS between April 2010 and October 2014 were recruited through the Minnesota Cancer Surveillance System. Patients completed a comprehensive questionnaire to capture retrospective epidemiologic data. All cases went through central medical review including pathology review by two independent hematopathologists, cytogenetic analyses, and oncologist medical record review with assignment of IPSS, IPSS-R, WPSS 1.2 noting past medical history, exposures, and treatment history and response. Annual clinical review of all patient cases for four years after initial enrollment is ongoing in a batched, non-real time manner.Three hundred and ninety-nine patients with a confirmed diagnosis of MDS based on central review and one year of clinical follow-up review were included in the analysis. For the entire group, we observed early mortality in those with abnormal cytogenetics, three or greater cytogenetic abnormalities, treatment at a community medical center only (versus academic), and with 2-3 concurrent medical comorbidities (Table 1). Treatment with hypomethylating agents also correlated with early mortality but when adjusted for WPSS and IPSS-R, this association was no longer significant.To investigate varied impact of disease and patient characteristics within different groups of MDS patients, we did multivariable regression analysis within the following categories: High/Very High Risk IPSS-R; Very low/Low/Intermediate Risk IPSS-R; Treated Patients; Supportive Care Only Patients. In patients with high or very high risk IPSS-R, the presence of 3 or more cytogenetic abnormalities was the only significant predictor early mortality in a multivariable adjusted model (OR: 3.66, 95% CI: 1.57-8.53). Similarly, in those with very low, low, or intermediate IPSS-R, abnormal cytogenetics was the only significant predictor of early mortality in an adjusted model (OR: 3.71, 95% CI 1.49-9.26).In patients receiving supportive care only, early mortality was seen in those who had diabetes (OR: 3.06, 95% CI 1.11-8.42), had complex cytogenetics (OR for ≥ 3 abnormalities: 4.94, 95% CI 1.25-19.46), and had very high or high IPSS-R (OR: 4.20, 95% CI 1.43-12.34). Likewise, complex cytogenetics remained the sole significant predictor of early mortality in treated patients (OR: 4.84, 95% CI 1.43-16.37).Complex cytogenetics and prognostic risk category (either by WPSS or IPSS-R) have previously been associated with higher risk disease and early mortality without intervention. Our data confirm this association in a large prospectively followed MDS cohort and highlight the significance of cytogenetic abnormalities and complexity regardless of IPSS-R risk categorization or treatment. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Thinking beyond surgery in the management of renal cell carcinoma: the risk to die from renal cell carcinoma and competing risks of death

The presentation of renal cell carcinoma (RCC) has changed where it is most commonly identified when asymptomatic and incidental. Contemporary patients with renal tumors are often older in age and may have significant concurrent medical comorbidity, where proceeding with routine surgical treatment may not be of benefit. Traditional clinical assessments have not considered the impact of comorbidity on oncologic outcome, and recent studies have demonstrated the relationship between comorbidity and patient survival. We review the existing data examining the significance of medical comorbidity on RCC management and outcomes. The existing literature on this topic is reviewed, and validated measures of comorbidity are described. The available studies examining the relationship between comorbidity and RCC are summarized. The article reviews the growing body of literature supporting the importance of assessment of patient comorbidity, and we highlight novel prognostic instruments that can estimate the likelihood of several different patient outcomes following RCC treatment, and these nomograms can be accessed via a web-based portal ( www.cancernomograms.com ) to assist in patient education and clinical decision making.

Clinical Evaluation of Chronic Hepatitis C and Indications for HCV Treatment

Hepatitis C virus (HCV) is the most common cause of liver cirrhosis in the United States. If untreated, HCV can lead to death from complications of liver failure or hepatocellular carcinoma, making screening imperative in high-risk patients. Established risk factors for HCV infection include injection drug use, receipt of blood transfusion or organ transplantation prior to 1992, and hemodialysis. Recent evidence has demonstrated that those born between 1945-1965 are additionally at high risk for HCV acquisition and should undergo one time screening. Once diagnosed, consideration for treatment should be based on patient motivation, concurrent medical co-morbidities, degree of liver injury, and risk of progression to cirrhosis. Therapy may also be indicated in patients with extra-hepatic manifestations of HCV.

Medical comorbidity in in-patients with psychiatric disorder

Objective: To study the prevalence of concurrent medical comorbidity in patients admitted with psychiatric disorders. Materials and Methods: One hundred patients with psychiatric disorders admitted to the general wards of the Department of Psychiatry, Father Muller Medical College, Mangalore were assessed for evidence of concurrent medical comorbidity. The assessment included clinical examination and investigations. Results: 49% of in-patients with psychiatric disorders had medical comorbidity. 26% of patients with bipolar disorder, 13% of patients with schizophrenia and 8% of patients with depressive disorders had medical comorbidity. Diabetes mellitus, hypothyroidism, and hypertension were the most common medical comorbidity. The medical comorbidity was not related to any of the socio-demographic variables. The medical comorbidity was not related to the clinical variables such as duration, age of onset of the psychiatric disorders. The medical comorbidity was significantly more in patients with bipolar mood disorder. Conclusions: 49% of in-patients with psychiatric disorders have concurrent medical comorbidity. Diabetes mellitus is the most common medical comorbidity. The present investigation is an observational, descriptive, cross-sectional clinical study. It has certain merits and limitations. Future studies with more refined methodology are required to draw definite conclusions.

Prevalence of medical comorbidity in alcohol dependence syndrome

Objective: Diverse medical conditions are associated with alcohol use disorders. Early diagnosis, prompt intervention, and treatment will reduce the morbidity and mortality and improve the quality of life. The aims of this study are to evaluate the frequency and nature of medical comorbidity in inpatients with alcohol dependence syndrome and to study the relationship between medical comorbidity and clinical and sociodemographic factors. Materials and Methods: This is an observational, descriptive, cross-sectional clinical study conducted on 100 consecutive patients with ICD10 diagnosis of alcohol dependence syndrome admitted to the deaddiction center, department of psychiatry, Father Muller Medical College Mangalore. All patients were assessed for evidence of concurrent medical comorbidity. Appropriate scales were used for assessment. Medical diagnosis was based on clinical findings, laboratory, and radiological investigations. The data of 100 patients were analyzed with appropriate statistical methods. Results: 65% of inpatients with alcohol dependence syndrome have medical comorbidity, of which 23% of alcohol-dependent individuals have diabetes mellitus, 20% have hypertension, and 51% of subjects have other medical comorbidities. Conclusion: The prevalence of medical comorbidity particularly diabetes mellitus and hypertension is significantly higher in inpatients with alcohol dependence syndrome. Our findings points to the importance for the need for early diagnosis of comorbid medical diseases.

Bouveretʼs Syndrome: A Case Report of Upper GI Bleeding

Purpose: Results: A 71 year old woman presented with a two week history of progressive epigastric abdominal pain, nausea and vomiting with eventual “coffee ground” emesis. She carried a number of comorbid conditions including obesity, diabetes, hypertension, hyperlipidemia, atrial fibrillation and systolic dysfunction. Physical examination on presentation was remarkable for right-sided abdominal pain, upper quadrant greater than lower. Laboratory evaluation revealed little information with no elevation in white blood cell count, normal metabolic parameters and normal liver function tests. CT scan was performed with an indication of right upper quadrant pain showing a large 3.8 cm×2.0 cm gallstone within a dilated, possibly intussuscepted duodenum. Also seen was air within the biliary tract and gallbladder indicating the likelihood of a chole-enteric fistula. Endoscopy was performed showing a large, darkly pigmented, occlusive stone in the third portion of the duodenum. A Holmium laser catheter was placed in an effort to fragment the stone without success. Exploratory laparotomy was performed for stone extraction. A firm inflammatory mass was seen in the right upper quadrant with considerable distortion of the anatomy. Multiple unsuccessful attempts were made to manually fracture the stone with eventual duodenotomy required for delivery. Conclusion: Gallstone ileus is an infrequent complication of cholelithiasis responsible for 1 to 4% of cases of mechanical obstruction in all comers, though has been noted as a cause of approximately 25% of non-strangulated bowel obstruction in patients older than 65. The most common site for gallstone impaction is the terminal ileum. Large stones such as this can impact immediately within the small bowel. Pericholecystic inflammation causes adhesions while pressure necrosis allows for eventual complete erosion into the duodenal lumen. Mortality remains high in this patient population at 15-18% thought most likely secondary to advanced age and concurrent medical comorbidity. Holmium:YAG laser therapy has been successfully reported in the literature. Definitive surgical therapy can consist of simple enterolithotomy, or more extensive procedure including simultaneous removal of the gallbladder and choleenteric fistula. It is important to note that surgical mortality with even the simple procedure approaches 10%.

Clinical Features of Depression in Outpatients With and Without Co-Occurring General Medical Conditions in STAR*D

Concurrent medical comorbidity influences the accurate diagnosis and treatment of major depressive disorder (MDD). The objective of this study was to validate previous findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study using a confirmation analysis in a previously unanalyzed cohort. Baseline cross-sectional case-control study of patients enrolling in a prospective randomized multistage treatment study of nonpsychotic MDD. Fourteen regional U.S. centers representing 18 primary care and 23 psychiatric practices. 2541 outpatients with DSM-IV nonpsychotic MDD. Sociodemographic status, medical illness ratings, psychiatric status, quality of life, and DSM-IV depression symptom ratings. The prevalence of significant general medical comorbidity in this population was 50.0% (95% CI = 48.1% to 52.0%), consistent with findings reported for the first cohort. Concurrent significant medical comorbidity was associated with older age, lower income, unemployment, limited education, and longer duration of index depressive episode. The group with significant medical comorbidity reported higher rates of somatic symptoms, gastrointestinal symptoms, sympathetic arousal, and leaden paralysis. These results were generally consistent between the 2 cohorts from STAR*D. Major depressive disorder with concurrent general medical conditions is associated with a specific sociodemographic profile and pattern of depressive symptoms. This association has implications for diagnosis and clinical care.

Prognostic Significance of Postoperative Morbidities in Patients With Advanced Epithelial Ovarian Cancer Treated With Neoadjuvant Chemotherapy and Delayed Primary Surgical Debulking

To examine the prognostic significance of postoperative morbidities in patients with ovarian cancer treated with neoadjuvant chemotherapy and interval surgical debulking. Retrospective chart reviews of all patients treated with neoadjuvant chemotherapy and interval debulking were performed from 1999 to 2002. Descriptive statistics were used to summarize the distributions of important clinical variables. Logistic regression was used to identify statistically significant predictors of postoperative morbidities. Cox regression was used to model time to first clinical progression. Survivals were estimated by the Kaplan-Meier method and compared with the log rank test. P < .05 was considered to be statistically significant. Fifty-eight patients were treated with neoadjuvant platinum-taxane combination chemotherapy. Major surgical complications were observed in four patients (6.8%). There were no perioperative deaths. The presence of concurrent medical comorbidities was associated with the development of significant postoperative morbidities (P = .038). Cox regression showed any macroscopic residual disease (P = .04) and the presence of significant postoperative morbidities (odds ratio, 4.7, 95% confidence interval, 1.8-12.7, P = .002) to be predictive of a shorter progression-free interval. Neoadjuvant chemotherapy followed by interval surgical debulking carried a low risk for postoperative morbidity. The adverse influence of marked postoperative morbidity on progression-free survival needs further study.

Calcanectomy for Treatment of the Infected Os Calcis

Osteomyelitis of the os calcis presents a difficult challenge to the treating physician. Because the condition often occurs in the setting of concurrent medical comorbidities, such as diabetes mellitus (DM), in adults, conservative treatment options are generally unsuccessful in eradicating the infection and preserving function of the extremity. However, limb-sparing surgery that effects cure of the infection is preferable because of the morbidity associated with amputation. The article presents a historical perspective on the various treatment options of the infected os calcis, the indications and contraindications for calcanectomy, and a description of the operative technique for calcanectomy. Complications and postoperative management, as well as the authors’ patient series results, are also presented.

Surgical Management of Early-Stage Endometrial Cancer in the Elderly: Is Laparoscopy Feasible?

Objective. To give insight into the utility of laparoscopic staging of endometrial cancer in the elderly population by reviewing the surgical management of clinically stage I endometrial cancer patients.Methods. A retrospective analysis evaluating patients that were ≥65 years old and had planned laparoscopic staging, traditional staging via a laparotomy, or a transvaginal hysterectomy as management of their early endometrial cancer. The laparoscopic group had complete staging with bilateral pelvic and paraaortic lymph node dissections and was compared to the group who had staging performed via laparotomy. Patients were identified by our institution's database and data were collected by review of their medical records. Data were collected on demographics, pathology, and procedural information including completion rates, operating room (OR) time, estimated blood loss (EBL), transfusions, lymph node count, complications, and length of stay. Associations between variables were analyzed by Student's t tests and χ2 testing using Excel v. 9.0.Results. From February 25, 1994, through December 21, 2000, 125 elderly patients were identified. Sixty-seven patients had planned laparoscopic staging (Group 1), 45 patients had staging via planned laparotomy (Group 2), and 13 patients had a transvaginal hysterectomy (Group 3). Group 1 and Group 2 were compared regarding surgical and postoperative data. Age was not different between these groups (75.9 vs 74.7 years, P = NS). Quetelet index was also similar (29.4 vs 29.9, P = NS) 32.8% of Group 1 had ≥1 previous laparotomy compared to 51.1% in Group 2 (P = NS). In Group 1, 53/67 (79.1%) had stage I or II disease compared to 29/45 (64.4%) in Group 2 (P = NS). Laparoscopy was completed in 52/67 (77.6%) attempted procedures. The reasons for conversion to laparotomy were obesity 7/67 (10.4%), bleeding 4/67 (6.0%), intraperitoneal cancer 3/67 (4.5%), and adhesions 1/67 (1.5%). OR time was significantly longer in successful Group 1 patients compared to Group 2 patients (236 vs 148 min, p = 0.0001). EBL was similar between these groups (298 vs 336 ml, P = NS). Ten of 52 (19.2%) of successful Group 1 patients received a blood transfusion compared to 1/45 (2.2%) of Group 2 patients (P < 0.0001). Pelvic, common iliac, and paraaortic lymph node counts were similar between successful Group 1 patients and those in Group 2 combined with those that received a laparotomy in Group 1 (17.8, 5.2, 6.6 vs 19.1, 5.1, 5.2, P = NS). Length of stay (LOS) was significantly shorter in Group 1 versus Group 2 (3.0 vs 5.8 days, P < 0.0001). There were less fevers (6.0 vs 15.6%, P = 0.01), less postoperative ileus's (0 vs 15.6%, P < 0.001), and less wound complications (6.0 vs 26.7%, P = 0.002) in Group 1 compared to Group 2. Group 3 average age was 77.5 years. Concurrent medical comorbidities were the main reason for the transvaginal approach. OR time averaged 104.5 min. The average length of stay was 2.1 days with no procedural or postoperative complications.Conclusions. The favorable results from this retrospective study refute the bias that age is a relative contraindication to laparoscopic surgery. Laparoscopic staging was associated with an increased OR time and an increased rate of transfusion but equivalent blood loss and lymph node counts. Possible advantages are decreased length of stay, less postoperative ileus, and less infections complications. Transvaginal hysterectomy still remains a proven option for women with serious comorbid medical problems with short OR times, minimal complications, and short lengths of stay.