Objective To investigate the occurrence and related influencing factors of early enteral nutritional intolerance after radical gastrectomy for gastric cancer. Method A total of 260 patients with gastric cancer who underwent laparoscopic radical resection in the First People's Hospital of Kashgar Prefecture from June 2021 to June 2024 were selected as the research subjects. They were divided into the tolerance group n = 188 and the intolerance group n = 72 according to whether there was feeding intolerance in enteral nutrition in the early postoperative period. The baseline data of the two groups were compared. Univariate and multivariate Logistic analyses were used to analyze the risk factors influencing early postoperative enteral nutrition intolerance in patients with gastric cancer and a comprehensive index was constructed based on the results of multivariate analysis. The receiver operator characteristic curve ROC curve was used to analyze the area under the curve AUC sensitivity and specificity of risk factors and comprehensive indices in predicting early postoperative enteral nutrition intolerance in patients with gastric cancer. Result The proportions of getting out of bed for activity ≤4 hours on the first day after surgery no use of nutrition pumps continuous enteral nutrition support starting enteral nutrition 24 h after surgery and serum albumin ≤35 g in the intolerance group were all higher than those in the tolerance group while prealbumin was lower than that in the tolerance group P<0. 05 . Multivariate Logistic regression analysis showed that the time of getting out of bed on the 1st day after surgery ≤4 h no use of nutrition pump continuous enteral nutrition support enteral nutrition starting 24 h after surgery and serum albumin ≤35 g were independent risk factors for early postoperative enteral nutrition intolerance in patients with gastric cancer P<0. 05 . ROC curve analysis showed that the AUC value sensitivity and specificity of early postoperative enteral nutritional intolerance in gastric cancer patients predicted by composite index were 0. 769 0. 722 and 0. 750. Conclusion Short time of getting out of bed on the first day after surgery ≤4 h no use of nutrition pump continuous enteral nutrition support early start of enteral nutrition after surgery within 24 h and low serum albumin level ≤35 g are all factors that have adverse effects on early postoperative enteral nutrition intolerance in patients with gastric cancer. Based on these factors a comprehensive index was constructed. It can provide reference for predicting the risk of early postoperative enteral nutrition intolerance so as to formulate targeted intervention measures to reduce the incidence of enteral nutrition intolerance.