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

This study aimed to investigate how COVID-19 affects patients with Gastric Cancer (GC) and what should be expected to happen in post-CVOID-19 era. A retrospective study of GC patients referring to Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences in two parallel time periods of February 25th to December 25th of 2020 and the same period in 2019 was conducted.  Twenty-six patients during COVID-19 pandemic and 54 patients during pre-COVID-19 time were recruited. Mean age, gender, tumor location and T status distribution did not show statistically significant difference between study groups (all p-values >0.05). Regarding N status, distributions of N0, N1, N2 and N3 in pre-COVID group were as follows: 2(3%), 21(39%), 25(48%) and 6(10%). In COVID-19 period, group N0 was not reported and N1, N2 and N3 were 7(27%), 7(27%) and 13(46%), respectively (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%) patients, respectively (all p-values <0.05). Health care systems should adopt reasonable approaches to cancer management, otherwise we might face the upcoming pandemic of locally advanced and metastatic cancers.