Background: The role of laparoscopic gastrectomy and D2 lymphadenectomy is not yet fully defined in patients treated with modern perioperative chemotherapy. In 2016, Kaiser Permanente Northern California regionalized gastric cancer care, introducing a regional comprehensive multidisciplinary care team, standardizing staging and chemotherapy, and implementing laparoscopic gastrectomy and D2 lymphadenectomy for eligible patients with curative-intent surgery. We previously reported a retrospective cohort study comparing treatments and outcomes before and after regionalization, including 2-year overall survival. Here we present updated 3-year overall survival. Methods: As we described previously (https://ascopubs.org/doi/full/10.1200/JCO.21.00480), the study included all 1429 patients with gastric cancer diagnosed during January 2010 to May 2018, of whom 942 were pre-regionalization, and 487 were post. Of the 1429, 650 had Stage I-III disease, and 394 patients underwent curative intent gastrectomy. 34.9% received neoadjuvant chemotherapy, and 18.4 % of patients received laparoscopic gastrectomy in the pre-regionalization period. In contrast, 66.2% received neoadjuvant chemotherapy, and 91.8% received laparoscopic gastrectomy with D 2 lymphadenectomy in the post regionalization period (p < 0.0001). Lymph node metastasis was noted in 50.7% and 45.1% pre- and post-regionalization periods, respectively (p = 0.29). Survival was analyzed using Kaplan-Meier analysis with entry on the diagnosis date, the outcome on the death date, and censoring on disenrollment or the end of the study. In this updated analysis, the end of the study was increased by one year to December 31, 2019. Results: The statistical analysis showed no difference in patients’ selection for surgery between the pre-and post-regionalization period and no change in the rate of surgical complications. At three years, overall survival among Stage I-III patients who received surgery was 66.0% in the pre-regionalization cohort and 83.0% in the post-regionalization cohort (p < 0.002), a more significant difference than was observed at two years. Conclusions: The utilization of laparoscopic surgery and radical D2 lymphadenectomy in the era of perioperative chemotherapy continues to demonstrate improved postoperative overall disease survival.