One Public Health Crisis into Many Others: The impact of COVID-19 on Upstaging of Gastric Cancer

Introduction: We aimed to investigate how COVID-19 affects patients with gastric cancer (GC) and what should be expected to happen in post-CVOID-19 era. Methods: A case-control study of GC patients referring to our center in two parallel time periods of February 25 th to December 25 th of 2020 and 2019 was conducted. Results: Twenty six patients during COVID-19 and 54 patients during pre-COVID-19 time were recruited. Mean age, gender, tumor location and T status distribution were not statistically different between study groups (all p values > 0.05). Regarding N status, distribution of N0, N1, N2 and N3 in pre-COVID group was as follows: 2(3%), 21(39%), 26(48%) and 6 (10%). In COVID-19 group N0 was not reported and N1, N2 and N3 were 7 (27%), 7 (27%) and 13 (46%) (p value < 0.05). Among pre-COVID patients 6 (11%) patients had gross metastasis in staging laparoscopy (SL) and 10 (18.5%) patients had positive malignant cytology. In COVID-19 group positive SL and positive cytology were found in 9(35%) and 11(42%), respectively (all p values < 0.05). Conclusion: Health care systems should adopt reasonable approaches to cancer management, otherwise the upcoming pandemic is locally advanced and metastatic cancers.