Impact of the COVID-19 Pandemic on Pathological Stage, Tumor Characteristics and Surgical Outcomes of Oral Squamous Cell Carcinoma: A Retrospective Analysis.

Background and Objectives: Oral Squamous Cell Carcinoma (OSCC) requires early diagnosis for favorable outcomes, but global healthcare disruptions caused by the COVID-19 pandemic severely affected cancer care delivery. This study aimed to investigate the pandemic's influence on OSCC pathological staging and disease-related characteristics at a single medical center. Materials and Methods: A retrospective study was conducted on 148 patients who underwent curative-intent surgery for newly diagnosed OSCC between March 2018 and October 2024. Patients were stratified into a Pre-COVID-19 group (March 2018-January 2020, N = 52) and a Post-COVID-19 group (February 2020-October 2024, N = 96). Patient demographics and risk factors were compared using Chi-squared and Wilcoxon rank-sum tests, while pathological stage, Depth of Invasion (DOI), and surgical outcomes were analyzed. Results: Patient demographics, risk factors, and comorbidities were comparable between the two groups. The Post-COVID-19 cohort presented with significantly more advanced pathological disease, evidenced by an increase in overall TNM stage, including a dramatically higher rate of Stage 4 diagnosis (35% vs. 3.2% in the Pre-COVID-19 group). This group also showed a significantly higher Depth of Invasion (median DOI: 5.0 mm vs. 3.0 mm). Consequently, the Post-COVID-19 group required more aggressive treatment (e.g., higher rates of adjuvant radiotherapy) and experienced worse short-term outcomes, including significantly longer hospitalization (median 15 days vs. 6 days) and higher rates of postoperative pulmonary infection and tracheostomy. Conclusions: The COVID-19 pandemic was associated with a dramatic shift toward the diagnosis of OSCC at advanced pathological stages. This diagnostic delay necessitated more complex surgical management and resulted in significantly worse short-term outcomes. These findings underscore the urgent need for resilient strategies to prevent systemic diagnostic delays during public health crises.