Poor nutritional status pre-surgery leads to worse outcomes in gastric cancer patients undergoing radical gastrectomy.

• Low preoperative prognostic nutritional index (PNI) increases overall survival risk by 34% and disease-free survival risk by 22%.
• Patients with lower PNI and higher nutritional risk scores face 6.31 days more in the hospital and higher costs after complications.

Screening for nutritional status should be integrated into protocols to identify high-risk patients and improve recovery.

• Combining PNI with nutritional risk screening enhances predictive accuracy for complications (area under the curve: 0.657 vs. 0.541 for PNI alone).