Background: Adjuvant chemotherapy for gastric cancer after gastrectomy with D2 dissection can be recommended. However, there are limited data of survival benefit in the elderly. We sought to investigate the use of adjuvant chemotherapy for patient ≥70 years old with stage II or III gastric cancer and identify its impact on survival. Methods: Patient ≥70 diagnosed with stage II or III gastric cancer at the Ulsan University Hospital from 2008-2012 were identified. A retrospective analysis of electronic and paper patient records was performed to identify baseline characteristics, chemotherapy used, toxicity, and survival. Results: A total of 277 patients ≥70 years old underwent gastrectomy with D2 dissection from 2008-2012. Of these, 94 patients were pathologically diagnosed as stage II or III gastric cancer. Among the 94 patients, 58.5% of patients (n=55) received adjuvant chemotherapy and 39 patients received regular check-up without chemotherapy. Fluoropyrimidine alone regimens including TS-1 (n=26) and Didox (n=22) were more commonly used compared with fluroropyrimidine-platinum combination regimens (n=7). With median follow-up of 30.9 (range, 0.8-65.5 months), the median relapse-free survival (RFS) of patients with adjuvant chemotherapy or regular follow-up only was 39.1 and 26.1 months (P = 0.027). Multivariate analysis revealed that the adjuvant chemotherapy was associated with longer RFS (hazard ratio 0.51; 95% confidence interval 0.27 – 0.98). There was a trend toward improved overall survival (OS) in the adjuvant chemotherapy group, with a median OS of 51.2 months compared with that of 44.5 months in the regular follow-up only group (P= 0.242). Toxicities in adjuvant chemotherapy were generally tolerated. Conclusions: In elderly patients (aged 70 or older) with stage II or III gastric cancer after gastrectomy with D2 dissection, adjuvant chemotherapy may carry a potential survival benefit for those who receive it. Further well-designed prospective studies are needed to confirm these finding.