Intraoperative indocyanine green (ICG) fluorescence imaging did not provide a clinically relevant benefit for lymph node dissection in gastric cancer surgery among western patients.

• A change in surgical conduct occurred in 19.3% of patients, with additional lymph nodes retrieved in 77% of these cases; however, only 21.3% of these additional nodes showed metastasis.
• Stage migration was rare, affecting only 0.9% of patients.

Surgeons should be cautious in applying ICG fluorescence for improved lymphadenectomy in this population, as the high false-positive rate limits its utility.