Objective To investigate the status quo of postoperative recurrence of gastric cancer and to analyze factors affecting it in the elderly patients with radical gastrectomy. Methods The study included 428 patients who underwent radical gastrectomy in Qionghai Hospital of Traditional Chinese Medicine from January 2015 to January 2020, and they were divided into the elderly group (age≥60 years; n=207) and the middle-aged and young group (18 years ≤ age <60 years; n=221). The patients were followed up until January 2023, and the recurrence rate of gastric cancer was statistically analyzed. Cox proportional hazard regression model was used to analyze the factors affecting the postoperative recurrence in the elderly patients with gastric cancer. Flow cytometry was employed to detect the Th1/Th2 of peripheral blood CD4⁺ cells in the elderly patients with or without recurrence of gastric cancer, and Pearson or Spearman correlation analysis was employed to analyze the relationship between Th1/Th2 cytokines levels of peripheral blood CD4⁺ cells and risk factors of recurrence of gastric cancer. SPSS 19.0 was used for statistical analysis. Data comparison between two groups was preformed using t test or χ² test depending on data type. Results The recurrence (30.43%) rate of gastric cancer in the elderly group was higher than that in the young and middle-aged group (16.29%; P<0.05). Cox multivariate regression analysis suggested that anesthesia risk (HR=1.162, 95%CI 1.021-2.744), T staging (HR=3.877, 95%CI 1.516-9.854), N staging (HR=4.211, 95%CI 1.543-11.574), TNM staging (HR=8.241, 95%CI 1.547-40.559) and postoperative adjuvant chemotherapy (HR=0.501, 95%CI 0.324-0.774) were factors affecting the recurrence in the elderly patients with gastric cancer after radical gastrectomy (P<0.05). The levels of Th1 cytokines and Th1/Th2 in peripheral blood were lower and the levels of Th2 cytokines were higher in the recurrence group than those in the non-recurrence group, and the differences were statistically significant (P<0.05). Correlation analysis indicated that Th1/Th2 of peripheral CD4⁺ cells in the recurrent gastric cancer was negatively correlated with recurrence high-risk factor TNM staging (r=-0.358, P<0.001), and was positively correlated with postoperative adjuvant chemotherapy (r=0.326, P<0.001). Conclusion The recurrence rate in the elderly patients with gastric cancer after radical surgery is higher than that in the middle-aged and young patients. Besides the common clinicopathological features, the risk of preoperative anesthesia and presence or absence of postoperative adjuvant chemotherapy are also factors affecting postoperative recurrence of the elderly gastric cancer. In addition, there is a significant shift from Th1 to Th2 in the elderly patients with gastric cancer recurrence. It is speculated that TNM staging and postoperative chemotherapy may be involved in gastric cancer recurrence by affecting Th1/Th2 drift.