Background <p>The SENORITA phase III trial demonstrated the effectiveness of laparoscopic sentinel node navigation surgery (LSNNS) in preserving stomach function for patients with early gastric cancer (EGC), although some patients experienced surgical failure or recurrence. The purpose of this study was to analyze patients’ clinicopathologic features from the SENORITA trial who were allocated to LSNNS with stomach-preserving surgery but ultimately did not preserve stomach or experienced recurrence.</p> Patients and Methods <p>Patients were categorized into two groups: the failure group (stomach preservation failure or cancer recurrence after LSNNS) and the success group (stomach preservation without recurrence following LSNNS). This study analyzed the detailed clinicopathologic characteristics of patients in the failure group from the SENORITA trial.</p> Results <p>Among 258 patients who underwent LSNNS, 193 patients (74.8%) achieved stomach preservation, while 65 patients (25.2%) failed to preserve. Intraoperative failure was the most common cause of unsuccessful stomach preservation, occurring in 35 of 65 cases (53.8%). Advanced pathological TNM stage was the only independent risk factor by multivariate analysis, with stage IB and IIA patients showing 5.9- and 45.0-fold higher failure risks. The main causes of failure included sentinel basin detection failure, metastatic lymph nodes, positive tumors at resection margins, and complications. The failure group also included five cases of gastric cancer recurrence following LSNNS.</p> Conclusion <p>Accurate preoperative staging and patient selection are crucial for optimizing LSNNS outcomes. Ensuring precise resection with an adequate number of harvested sentinel basin nodes is essential to succeed the stomach-preserving surgery.</p>