Background <p>With aging populations, elderly gastric cancer (GC) patients are increasing. D2 lymphadenectomy is widely accepted for advanced GC, but its efficacy and safety in elderly patients are still debated. To guide surgical decisions, we conducted a systematic review and meta-analysis evaluating optimal lymphadenectomy extent in elderly patients.</p> Methods <p>A systematic review was performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for reporting systematic reviews. Meta-analyses were performed regarding (i) total postoperative complications, (ii) pancreatic fistula, (iii) abdominal abscess, (iv) postoperative hospital stay, and (v) overall survival by using R software.</p> Results <p>Seven retrospective studies met eligibility criteria, including three with propensity score matching. Meta-analysis showed that complication rates (any grade) were similar, while severe complications (grade ≥ 3) tended to be lower with limited lymphadenectomy. Pancreatic fistula rates showed no significant difference, but limited lymphadenectomy was significantly associated with reduced abdominal abscess incidence (RR: 0.15, <i>p</i> = 0.013). Postoperative hospital stay did not differ significantly between the groups. Furthermore, no significant difference in overall survival was observed between the groups (HR: 0.94, <i>p</i> = 0.834).</p> Conclusion <p>Limited lymphadenectomy may be a reasonable surgical option for elderly GC patients, as it reduces the risk of abdominal abscess without compromising long-term survival. These findings support a more tailored surgical approach based on patient age and risk profile.</p>