title: Minimally invasive surgery for endometrial cancer: does operative start time impact surgical and oncologic outcomes?
abstract: OBJECTIVE
  Recent literature in ovarian cancer suggests differences in surgical outcomes depending on operative start time. We sought to examine the effects of operative start time on surgical outcomes for patients undergoing minimally invasive surgery for endometrial cancer.
  
  
  METHODS
  A retrospective review was conducted of patients undergoing minimally invasive surgery for endometrial cancer at a single institution between 2000 and 2011. Surgical and oncologic outcomes were compared between patients with an operative start time before noon and those with a surgical start time after noon.
  
  
  RESULTS
  A total of 380 patients were included in the study (245 with start times before noon and 135 with start times after noon). There was no difference in age (p=0.57), number of prior surgeries (p=0.28), medical comorbidities (p=0.19), or surgical complexity of the case (p=0.43). Patients with surgery starting before noon had lower median BMI than those beginning after noon, 31.2 vs. 35.3 respectively (p=0.01). No significant differences were observed for intraoperative complications (4.4% of patients after noon vs. 3.7% of patients before noon, p=0.79), estimated blood loss (median 100 cc vs. 100 cc, p=0.75), blood transfusion rates (7.4% vs. 8.2%, p=0.85), and conversion to laparotomy (12.6% vs. 7.4%, p=0.10). There was no difference in operative times between the two groups (198 min vs. 216.5 min, p=0.10). There was no association between operative start time and postoperative non-infectious complications (11.9% vs. 11.0%, p=0.87), or postoperative infections (17.8% vs. 12.3%, p=0.78). Length of hospital stay was longer for surgeries starting after noon (median 2 days vs. 1 day, p=0.005). No differences were observed in rates of cancer recurrence (12.6% vs. 8.8%, p=0.39), recurrence-free survival (p=0.97), or overall survival (p=0.94).
  
  
  CONCLUSIONS
  Our results indicate equivalent surgical outcomes and no increased risk of postoperative complications regardless of operative start time in minimally invasive endometrial cancer staging, despite longer length of hospital stay for surgeries beginning after noon.
authors.affiliation: Department of Gynecologic Oncology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Katrina N
authors.initials: KN
authors.lastname: Slaughter
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA.
authors.forename: Alpa M
authors.initials: AM
authors.lastname: Nick
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA.
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Fleming
authors.affiliation: Hospital de Câncer de Barretos, Gynecologic Oncology Department, Antenor Duarte Vilela 1331, Barretos, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: dos Reis
authors.affiliation: Department of Biostatics, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Westin
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA.
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Medical Cancer Center, Houston, TX, USA. Electronic address: peramire@mdanderson.org.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endometrial cancer; Laparoscopy; Start time