Background and Aims The completeness of lymph node dissection in laparoscopic radical gastrectomy for gastric cancer directly affects postoperative patient prognosis. Indocyanine green (ICG) fluorescence-guided navigation, as an emerging auxiliary technique, enables real-time visualization of lymphatic drainage pathways and enhances surgical precision. This study was performed to evaluate the impact of ICG fluorescence navigation on lymph node dissection, positive lymph node detection, and patient prognosis during laparoscopic D₂ radical gastrectomy for gastric cancer.Methods The clinical data of 168 patients who underwent laparoscopic radical gastrectomy at Zhangzhou Affiliated Hospital of Fujian Medical University from January 2021 to December 2022 were retrospectively analyzed. Among them, 51 patients received ICG-guided surgery (ICG group), and 117 underwent conventional surgery (non-ICG group). Perioperative variables, extent of lymph node dissection, positive lymph node detection efficiency, and postoperative survival outcomes were compared between the two groups.Results There were no statistically significant differences between the two groups in baseline clinicopathologic characteristics, as well as operative time, intraoperative blood loss, postoperative recovery, and incidence of surgical complications (all P>0.05). The ICG group had a significantly higher mean number of lymph nodes dissected than the non-ICG group (48.62 vs. 37.20, P<0.001), with a greater proportion of patients achieving ≥30 nodes dissected (92.16% vs. 69.23%, P=0.001). Stratified analysis showed a significantly higher number of dissected lymph nodes in the ICG group at D₂ stations, the supra-pancreatic region (stations 7, 8, 9, 11), in total gastrectomy, T3-4 stage, and stage Ⅲ patients (all P<0.01). In the ICG group, the number and positivity rate of fluorescent lymph nodes were significantly higher than those of non-fluorescent nodes (30.31 vs. 17.36; 2.03 vs. 0.94, both P<0.05). The diagnostic sensitivity of ICG fluorescence imaging for positive lymph nodes was 68.4%, with a negative predictive value of 94.6% for non-fluorescent nodes. No significant differences were observed between the two groups in terms of adjuvant therapy, overall survival (HR=0.737, P=0.471), or disease-free survival (HR=0.502, P=0.089).Conclusion ICG-guided navigation in laparoscopic radical gastrectomy for gastric cancer is safe and significantly improves lymph node yield, particularly in the supra-pancreatic region, total gastrectomy, and advanced-stage patients. It also enhances positive node detection. However, no survival benefit has been observed in the short term. Further multicenter studies with long-term follow-up are warranted to confirm its clinical value and optimize intraoperative navigation strategies.