Surgeons need to consider that extensive perigastric dissection during cytoreductive surgery can impair postoperative recovery without affecting oncologic outcomes.

• Patients undergoing severe perigastric dissection (GCL4) had delayed oral intake, longer reliance on parenteral nutrition, and extended hospital stays.
• Major morbidity, 30-day mortality, and long-term survival rates remained consistent across surgical levels.

Tailoring recovery strategies may be essential for patients with extensive dissection; an exploratory nomogram can help predict nutritional needs post-surgery.

• Key predictors of delayed recovery included female sex, longer operative time, and the extent of perigastric dissection.