Background <p>Lymph node yield is an important surrogate parameter for assessing the oncological radicality of the resection of gastric carcinomas, as well as a prognostic factor in this disease. There is evidence to suggest neoadjuvant therapy lower the lymph nodal yield in other malignancies. The aim of this study was to determine the effect of neoadjuvant chemotherapy on lymph node yield and lymph node ratio (LNR), and to evaluate whether LNR correlates better with recurrence risk than absolute nodal yield in patients undergoing curative gastrectomy.</p> Methods <p>This was a retrospective analysis of all the cases operated over a period of 3 years from 2020 to 2023. The primary endpoint included the number of lymph nodes identified in the resected specimen. Secondary endpoints included number of positive nodes, lymph nodal ratio, recurrence rates. Using appropriate statistical methods, the endpoints between patients with and without neoadjuvant therapy, as well as in defined subgroups was compared.</p> Results <p>A total of 120 patients were included; 33.3% received neoadjuvant chemotherapy and 66.7% underwent upfront surgery. The mean lymph node yield was significantly lower in the post-chemotherapy group compared to the upfront group (16.33 vs. 22.15, <i>p</i> = 0.001). The lymph node ratio (LNR) was also significantly lower following neoadjuvant therapy (0.12 vs. 0.32, <i>p</i> = 0.001). When categorized into LNR groups (0%, 1–9%, 10–25%, &gt; 25%), the proportion of patients in the high-burden group (&gt; 25%) was significantly higher in the upfront surgery cohort (35 vs. 6 patients; <i>p</i> = 0.0087). Increasing LNR was associated with progressively higher recurrence rates, with recurrence seen in 8.8% (0% LNR), 18.8% (1–9%), 18% (10–25%), and 46.3% (&gt; 25%) (<i>p</i> = 0.001). Although the overall recurrence rate was higher in the upfront group, the distribution of recurrence pattern (local, peritoneal, local + distant, distant) was not significantly different between groups (<i>p</i> = 0.93). However, higher LNR (&gt; 25%) correlated with distant and peritoneal recurrence, irrespective of treatment arm.</p> Conclusion <p>Neoadjuvant therapy decreased nodal burden and LNR, and increasing LNR was associated with higher recurrence risk and may serve as a useful adjunct for risk stratification in patients undergoing gastrectomy after neoadjuvant therapy. However, LNR did not retain independent significance on multivariate analysis and should be interpreted alongside other clinicopathological factors. When the lymph node yield falls below required minimum, the threshold of what constitutes an adequate assessment should not be the number of nodes harvested, rather it should be completeness of D2 clearance.</p>