The development of Coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory disease coronavirus 2 (SARS-CoV-2), has produced a global public health catastrophe that has never been seen before. After the World Health Organization (WHO) declared COVID-19 a public health emergency on March 11, 2020, numerous nations stepped up their efforts to stop the virus from spreading and to treat COVID-19 patients [1]. The pandemic had a significant influence on the health-care system, as many other ailments that require attention were overlooked due to resource allocation. Cancers stand out among the diseases that have been unable to obtain adequate treatment, with significant consequences [2].

Locoregional lymph nodes/ LNs are the earliest and commonest sites of metastasis of solid tumors such as carcinoma of the breast [3]. As tumors grow and evolve, they metastasize to regional lymph nodes, which are of significant prognostic importance. Persistent disease in lymph nodes can be the source of subsequent fatal metastases if not resected completely [4]. Therefore, improvement in local therapy is associated with better prognosis.

This is a retrospective study conducted between January to March of 2019 and 2021 among patients who underwent surgeries for carcinomas in the general surgery department of Saveetha Medical College and Hospital, Chennai. A total of 40 patients were taken in this study, out of which 20 cases were taken before the covid-19 pandemic in 2019, and 20 cases during the covid-19 pandemic in 2021. We included carcinoma of breast, thyroid, stomach and rectum for this study. Radical resection of tumour along with lymph node dissection was performed. The resected lymph nodes were sent for histopathological examination and the average node positivity rate was calculated. The study was conducted as per the guidelines and approval of the Institutional Ethics Committee, the ethical clearance study number being: SMC/IEC/2021/03/088. Informed consent was obtained from the patients. Odds ratio was used to measure the association between pre covid era (PCE) and covid era (CE). p value < 0.05 was considered as statistically significant. All statistical analysis was done by using SPSS software Version 21.

A total of 40 cancer patients underwent surgery from our department in the time period used for the study; 20 during the COVID period and 20 from the pre-COVID era. A tabulation of the type of cancers in our study is given in Table 1 and Figure 1.

The probability of lymph node involvement among cancer patients in 2019 and 2021 is shown in Table 2. Figure 2 depicts the prevalence of node positivity in cancer patients during the years 2019 and 2021.

Table 3 and Figure 3 depicts the average node positivity rate for individual cancers in PCE and CE.

The outbreak of COVID-19 posed major healthcare, scientific, and economic challenges globally. These ranged from shortage of personal protective equipment and testing kits to lack of clear guidelines on the management of non- COVID patients during the pandemic. This required a thorough consideration and risk assessment on a case-to-case basis along with re-prioritizing of current waiting lists [5-7].

Early experience from China suggested that the COVID-19 pandemic clearly influenced the care of patients with cancer surgeries were especially more affected than emergency surgeries [8,9]. Utilizing our newly designed list prioritization and careful patient selection, we were able to increase our cancer resection numbers almost same when compared to the same time frame a year ago.

The presence of metastasis to regional lymph nodes is of special importance as it determines treatment protocol and overall prognosis of the patient [10-12]. During the covid-19 pandemic there was a delay in the presentation of patients with undetected malignancies to the outpatient department. This delay can be attributed to several factors some of which are the lockdown which was enforced, travel restrictions, logistical constraints and so on.

And so, by the time they underwent surgery for resection of the tumour along with removal of regional lymph nodes, there was already significant nodal metastasis.

Our study helps surgeons to be vigilant and explore the dissecting field completely to ensure all involved lymph nodes are resected during surgery to avoid recurrence and to improve overall prognosis of the patient in the forthcoming months.

During the Covid-19 pandemic there was a considerable reduction and delay in patients that presented to the OPD for symptoms of malignancies. This has led to a delay in diagnosing and treating malignancies in advanced stages which is reflected as metastasis to regional lymph nodes which were resected along with the tumour during surgery. Awareness among patients should be improved to ensure early presentation and reporting of symptoms. Surgeons must be more vigilant and explore the dissecting field completely to ensure all involved lymph nodes are resected during surgery, to avoid recurrence and to improve overall prognosis of the patient in the forthcoming months.