Background and Aims Visceral obesity is not only a risk factor for various cancers but also closely related to surgical outcomes and the occurrence of postoperative complications. Although there are numerous studies on the impact of visceral fat area (VFA) on the efficacy and postoperative complications of radical gastrectomy as well as postoperative survival of patients, there is still a lack of comparative analysis with large sample sizes. Therefore, this study was performed to explore the relationship between VFA defined by CT at the third lumbar vertebra level (L3-CT) and the efficacy, postoperative complications, and prognosis of radical gastrectomy through a Meta-analysis.Methods A comprehensive search was conducted across multiple domestic and international databases to collect clinical studies comparing the postoperative outcomes of gastric cancer patients with different VFAs (all calculated by L3-CT). The search period was from the inception of the database to July 2023. After literature screening according to inclusion and exclusion criteria, data extraction, Meta-analysis was performed using RevMan 5.3 software.Results A total of 9 studies meeting the criteria were included, with 6 retrospective cohort studies and 3 prospective studies, comprising a total sample size of 4 521 cases. The NOS scores of the included studies ranged from 7 to 9. Meta-analysis results showed that the high VFA group had longer operative time (MD=19.59, 95% CI=0.93-38.25, P=0.04), greater blood loss (MD=60.79, 95% CI=10.20-111.38, P=0.02), and fewer lymph nodes dissected (MD=-4.85, 95% CI=-6.11--3.60, P<0.000 01). The high VFA group also had prolonged postoperative hospital stay (MD=1.75, 95% CI=0.99-2.51, P<0.000 01). VFA was associated with the overall incidence of complications (OR=1.57, 95% CI=1.32-1.87, P<0.000 01), with the high VFA group more likely to develop pancreatic fistula (OR=2.58, 95% CI=1.41-4.69, P=0.002) and anastomotic leakage (OR=1.77, 95% CI=1.12-2.79, P=0.01). There was no statistically significant difference in the 5-year survival rate between the different VFA groups (OR=1.17, 95% CI=0.92-1.49, P=0.21).Conclusions High VFA prolongs operative time, with increased intraoperative blood loss, reduced the number of lymph nodes dissected, and makes patients more prone to pancreatic fistula and anastomotic leakage. Due to the limitations in the number and quality of studies, these conclusions require further validation through higher quality studies.