Objectives This study was done to determine whether time from optimal cytoreductive surgery (CRS) to initiation of adjuvant chemotherapy impacts disease free & overall survival in advanced ovarian carcinoma.

Methods 185 patients underwent optimal cytoreduction (either as upfront or interval) & recieved adjuvant chemotherapy. The analysis of time interval between day of surgery and start of adjuvant chemotherapy and its impact on outcome was done.

Results CRS with intraperitoneal chemotherapy either in the form of intraperitoneal port (IP port) or hyperthermic intraperitoneal chemotherapy (HIPEC) was done in 118 patients (43+ 75) and CRS alone in 46 patients. Median interval between surgery and initiation of adjuvant chemotherapy was 35 days for the cohort (32 days in the CRS alone group, 34 days in CRS+ IP port group and 41 days in CRS+ HIPEC group). Median disease free interval (DFS) was 28, 36 and 33 months respectively in the three groups. Delay in chemotherapy, defined as more than 40 days had significant impact on DFS in CRS alone group (36 months vs 17 months: p=0.02), but had no impact in the patient who were receiving intraperitoneal chemotherapy. No statistically significant difference in the overall survival (OS) was observed in patients whose adjuvant chemotherapy was delayed (88 months versus71 months, p=0.49).

Conclusions Delay in starting adjuvant chemotherapy adversely affects DFS. Intra-peritoneal chemotherapy after optimal CRS can improve DFS. However well designed clinical studies needs to be designed to evaluate the impact of single dose of intraperitoneal heated therapy & its interplay in delay on starting adjuvant chemotherapy.