Recurrence after curative gastrectomy significantly reduces survival, especially in patients with high lymph node ratios (LNR).

• The probability of being alive and recurrence-free drops from 66.5% at 12 months to just 33.6% by 58 months.
• In high-LNR patients, 100% experience recurrence by 36 months, and only 11.3% are alive after recurrence at 12 months.
• Low-LNR patients fare better, with an extended survival period allowing for a lower mortality rate post-recurrence (62.5% vs. 80% over 24 months).

Surgeons should prioritize LNR in counseling and monitoring post-gastrectomy patients, as it crucially affects outcomes.