Impact of operative start time on surgical outcomes in patients undergoing primary cytoreduction for advanced ovarian cancer

Objectives. To evaluate the impact of operative start time (OST) on surgical outcomes in patients with advanced ovarian cancer. Methods. All stage IIIB-IV serous ovarian cancer patients who underwent primary surgery at our institution from 1/01 to 1/10 were identified. Fourteen factors were evaluated for an association with surgical outcomes including OST and OR tumor index (1 point each for carcinomatosis and/or bulky [>= 1 cm] upper abdominal disease). Univariate logistic regression considering within-surgeon clustering was performed for cytoreduction to <= 1 cm versus > 1 cm residual disease. In patients with <= 1 cm residual disease, univariate logistic regression considering within-surgeon clustering was performed for 1-10 mm residual disease versus complete gross resection (CGR, 0 mm residual). A multivariate logistic model was developed based on univariate analysis results in the <= 1 cm residual disease cohort. Results. Of 422 patients, residual disease was: 0 mm, 144 (34.1%); 1-10 mm, 175 (41.5%); > 10 mm, 103 (23.3%). OST was not associated with cytoreduction to <= 1 cm residual disease on univariate analysis. In the <= 1 cm residual disease cohort, albumin, CA-125, ascites, ASA score, stage, OR tumor index, and OST were associated with CGR on univariate analysis. Earlier OSTs were associated with increased rates of CGR. On multivariate analysis, CA-125 was independently associated with CGR. OST was associated with CGR in patients with an OR tumor index of 2 but not an OR tumor index < 2. Conclusions. OST was not associated with cytoreduction to <= 1 cm residual disease in patients with advanced serous ovarian cancer. In the cohort of patients with <= 1 cm residual disease, later OSTs were associated with reduced rates of CGR in patients with greater tumor burden. (c) 2012 Elsevier Inc. All rights reserved.