Clinicopathological Characteristics and Survival Outcomes in Patients With Gastric Adenocarcinoma: A 16-Year Experience From a Single Tertiary Center in Tunisia

INTRODUCTION: Gastric cancer remains a leading cause of cancer-related mortality worldwide, with marked geographic disparities in presentation and outcomes. Surgical resection remains the cornerstone of curative treatment; however, survival and recurrence patterns vary according to clinicopathological features. OBJECTIVE: This study aimed to evaluate overall survival and recurrence outcomes after gastrectomy for patients with gastric adenocarcinoma and to identify independent prognostic factors in a North African tertiary-care setting. MATERIAL AND METHODS: We conducted a retrospective cohort study spanning 16 years, including 192 patients who underwent curative-intent or palliative gastrectomy for histologically confirmed gastric adenocarcinoma at a single tertiary center in Tunisia. Overall survival, locoregional recurrence, and distant metastasis were analyzed via the Kaplan-Meier method and Cox proportional hazards regression. RESULTS: The overall survival rates were 57.5% at one year, 22% at five years, and 14% at 10 years. On multivariate analysis, residual tumor, larger tumor size, and advanced pathological stage were independently associated with poorer survival. Locoregional recurrence occurred in 21.7% of patients and was independently associated with subtotal gastrectomy (hazard ratio (HR) = 2.81). Distant recurrence was observed in 41.4% of the patients and was independently associated with serosal invasion (HR = 2.88; p = 0.023) and an infiltrative tumor growth pattern (HR = 3.49; p = 0.002). CONCLUSION: These findings underscore the need for optimized surgical strategies and tailored multimodal treatment approaches, particularly in regions where advanced-stage presentation remains common.