On March the 9th, 2020, in Italy was established the first lockdown to deal with what would be declared by the World Health Organization (WHO) a few days later, on March the 11th, as the global Coronavirus Disease 2019 (COVID-19) pandemic 1, 2, 3.

Italy was one of the most affected countries, especially during the first wave of virus spread in Europe, with serious economic and social consequences.

The need to direct resources and capacity toward treating COVID-19 patients resulted in significant reduction or suspension of other elective and emergency healthcare provision, including cancer care. This dramatically impacted on routine diagnostic examinations, screening programs, elective oncological treatments and emergency surgery 4, 5, 6, 7, 8. Actually, how best to manage cancer patients became a major concern 9, 10.

Pancreatic cancer (PC) is still one of the deadliest malignancies in Western Countries. However, unlike other gastrointestinal cancers, PC is less frequently identified by means of screening programs, with most patients being diagnosed with specific symptoms at presentation [11].

Timely surgical resection is the mainstay of treatment for localized PC and prognosis is largely dependent on early presentation and prompt diagnosis 12, 13. Such clinical characteristics, together with the need for a specific multidisciplinary approach, in dedicated, high-volume facilities has posed particular difficulties during the pandemic era [11].

A large, cross-sectional study has examined changes in the number of patients with newly diagnosed malignancy before and during the pandemic in the United States. As for PC, the weekly number of newly identified patients demonstrated a 25 percent decline, which was significantly lower as compared to that shown by other malignancies such as breast, colorectal, and gastric cancer [14]. A recent, French multicenter cohort study similarly reported a referral fall by 29 percent of newly diagnosed PC patients due to the COVID pandemic [15]. However, clinical implications of such delays in PC diagnosis remain essentially uncertain and available evidence on the argument is still limited and discordant 9, 11, 15, 16. Some authors have reported that the percentage of localized disease has decreased over time, with a progressive rise in the number of patients presenting at advanced stages following the pandemic outbreak [11]. On the contrary, other analyses did not reveal any tumor stage shift or impairment in the treatment intent of PC patients 15, 16.

In particular, specific data on the clinical outcomes of surgically resected PC patients before and after the pandemic are limited 9, 17. Accordingly, in this article we aimed to perform a subgroup analysis using data from the COVID-Advanced Gastrointestinal Cancer Surgical Treatment (AGICT) study [4] to investigate whether the COVID-19 pandemic impaired the clinical history of PC patients.