title: Impact of operative start time on surgical outcomes in patients undergoing primary cytoreduction for advanced ovarian cancer.
abstract: OBJECTIVE
  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 >1cm residual disease. In patients with ≤ 1 cm residual disease, univariate logistic regression considering within-surgeon clustering was performed for 1-10mm residual disease versus complete gross resection (CGR, 0mm 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: 0mm, 144 (34.1%); 1-10mm, 175 (41.5%); >10mm, 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.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Tanner
authors.forename: Kara C
authors.initials: KC
authors.lastname: Long
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhou
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Brightwell
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Alexia
authors.initials: A
authors.lastname: Iasonos
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult