Operation start time and long-term outcome of hepatocellular carcinoma after curative hepatic resection

Purpose: The objective of the current study was to examine the potential effects of surgery start times (morning vs. afternoon) on the long-term prognosis of patients after hepatic resection (HR) for hepatocellular carcinoma (HCC). Methods: All eligible patients were divided into 2 groups according to the start time of surgery: group M (morning surgery, 8 AM-1 PM) and group A (afternoon surgery, 1 PM-6 PM). Ctinicopathologic and surgical parameters, as well as oncologic outcomes were compared between the 2 groups. Results: In total, 231 patients were included in the study. There was no difference in age, body mass index, comorbidities, tumor size, tumor location, tumor stages, surgical procedures, or surgical margin between morning and afternoon surgery (all P > 0.05). In contrast, patients in group M experienced longer operation duration than those in group A (median, 240 minutes vs. 195 minutes, P = 0.004). However, no differences of overall survival were observed between morning and afternoon surgery groups in the whole cohort or stratified by surgical margin (all P > 0.051). Conclusion: Surgery start times during the work day have no measurable influence on patient outcome following curative HR for HCC, indicating good self-regulation and professional judgment of surgeons for progressive fatigue during surgery.