Recent analysis reveals significant concerns in the quality of evidence supporting NCCN guidelines for gastric cancer treatment.

• Only 40% of 30 randomized trials (13,765 patients) reported statistically significant outcomes, with a median fragility index of just 6.
• Adjuvant chemotherapy trials had the highest fragility index at 20, raising questions on their reliability.

Surgeons should be cautious when applying these guidelines, as the underlying studies may not provide robust evidence for treatment decisions.

• Surgical trials had an average of 9 patients lost to follow-up, highlighting issues with study integrity.