The aim of this study was to evaluate the outcome for gastric cancer patients treated at a medium sized Norwegian hospital. The medical journals of all 356 patients with gastric cancer treated at Levanger Hospital from 1980 to 2004 were retrospectively analysed. Follow-up with regard to survival was complete. The Department of Surgery had treated 277 patients (78%). The resection rate of patients admitted to the Department of Surgery was 56% (154/277), and the total resection rate was 43% (154/356). R0 resection was done in 97 patients (27%), R1 resection in 16 (4%), palliative R2 resection in 41 (12%), other palliative procedures in 59 (17%), and only palliative care was given for 143 (40%) patients. The 30-days postoperative mortality was 2.7% (3/113) after R0 and R1 resections, 4.9% (2/41) after R2 resections, and 24% (14/59) after other palliative procedures. After R0 resections, the estimated overall 5-year survival was 39% (95% C.I. 29-49). After R1 and R2 resections, none survived 5 years and the estimated overall 2-year survival was 12% (95% C.I. 0-27%) and 2% (95% C.I. 0-7%), respectively. Estimated overall 5-year survival was closely related to stage: 91% (95% C.I. 74-100) in stage 1A, 64% (95% C.I. 53-74) in stage 1B, 27% (95% C.I. 10-44) in stage II, 18% (95% C.I. 4-32) in stage IIIA, and none in stages IIIB and IV. Dysphagia, fatigue, weight loss, palpable tumour, ascites and anaemia were related to a bad prognosis. Dyspepsia, vomiting and hematemesis were not related to the prognosis. Symptoms duration > 6 months were related to a better prognosis than short duration of symptoms < 2 months. The results from this hospital are in accordance with previous reports from the Western world.