The impact of the COVID-19 pandemic on the diagnosis and surgical treatment processes of gastric cancer.

Objective: This study aimed to evaluate the effects of the coronavirus disease-2019 (COVID-19) pandemic on the diagnostic and surgical treatment processes of gastric cancer. Three-year periods before and after the pandemic were compared to examine differences in the diagnostic process, disease stage, surgical extent, and survival. Material and Methods: A retrospective analysis was conducted on 395 patients who underwent resection surgery for gastric cancer between March 11, 2017, and March 11, 2023. Patients with incomplete data regarding the diagnostic and treatment processes, those deemed inoperable following exploratory surgery and subsequently referred for alternative treatment, and patients operated on at external centers were excluded. A total of 197 patients were analyzed and divided into two groups: pre-pandemic (PP, n=137) and post-pandemic (PS, n=60). Results: A significant decrease in the number of surgeries was observed in the PS group compared to the PP group. Significant differences were found between the two groups regarding locally advanced disease at diagnosis (T4/N+), the application rate of cytoreductive surgery+hyperthermic intraperitoneal chemotherapy, and follow-up mortality (p=0.031, p=0.028, and p=0.005). The overall mean survival was 50.02±2.78 months in the PP group and 32.52±2.24 months in the PS group (p=0.765). No significant differences were observed between the groups regarding the diagnostic process and pathological stages. Conclusion: The COVID-19 pandemic may have reduced both the referral rates for surgery and the extent of surgical interventions for advanced-stage gastric cancer. It is believed that both surgeons and patients adopted more conservative approaches during the pandemic.