Background <p>Evaluation was performed of the prognostic significance of concurrent presence of both lymphovascular invasion (LVI) and perineural invasion (PNI) compared to presence of either LVI or PNI and neither LVI nor PNI in gastric cancer patients undergoing curative treatment.</p> Methods <p>We analysed the prospectively maintained surgical oncology database from May 2016 to April 2024. Patients with gastric cancer who underwent curative surgery were included, and those with metastatic, unresectable disease or incomplete data were excluded. The patients were classified into three groups according to absence (-) or presence (+) of LVI and PNI, i.e., Group A with LVI- &amp; PNI-, Group B with LVI+ &amp; PNI- or LVI- &amp; PNI + and Group C with LVI+ &amp; PNI+.</p> Results <p>Total of 221 patients met the inclusion criteria. Neoadjuvant chemotherapy was received by 74(33.5%). After a median follow-up of 41 months, the median disease-free survival (DFS) for group A was not reached; the median DFS of group B was 36 months, and that for group C was 27 months (<i>p</i> = 0.005). The median overall survival (OS) in group A was not reached; The median OS of group B was 44 months, and that of group C was 30 months, respectively (<i>p</i> = 0.002). On multivariate analysis, presence of concurrent LVI/PNI (Group C) was an independent prognostic factor for both DFS [HR (C.I) = 2.9 (1.5–5.6), <i>p</i> = 0.001] and OS [HR (C.I) = 3.1 (1.6–6.1), <i>p</i> = 0.001].</p> Conclusions <p>Group C predicts worse DFS and OS compared to Group B, which was again worse compared to Group A in curatively treated gastric cancer patients.</p>