Introduction: Gastric adenocarcinoma (GAC) remains a lethal disease. Evidence suggests that there is increased incidence of gastric cancer among ethnic minorities as compared to whites. In addition, survival and treatment recommendations may vary based on geographic regions. Objectives: We sought to assess the impact of geographic region and race/ethnicity on treatment and survival for GAC. Methods: Data from SEER registry was used to identify patients with potentially resectable gastric adenocarcinoma (AJCC I–III) diagnosed 2004 to 2015. Exposures of interest were geographic region of diagnosis: Western (West), Midwestern (MW), Southern (SO) or North Eastern (NE), and race. The endpoints were: (1) recommendation of no surgery by the provider, (2) utilization of surgery, and (3) gastric cancer-specific survival (GCS). Multivariable logistic and Cox regression models were used to identify associations. Results: 15,991 patients were included in the analysis (West, 56.3%; NE, 16.3%; MW, 7.8%; and SO, 19.7%). On univariate analysis, the likelihood of no recommendation for surgery was highest in SO (OR: 1.35; P<.001;] West, referent). In adjusted analysis, it was lowest in NE and MW (NE aOR: 0.78; P<.001; MW aOR: 0.78; P=.002). The likelihood of no recommendation for surgery was lowest in Asians (AS) on univariate analysis (OR: AS, 0.47; P<.001); American Indian (AI) 0.59 (P=.027); Hispanic (HS) 0.85 (P=.018); whites (W) 1.01 (P=.884); Black (B) ref]. The adjusted analysis for W is (aOR: 0.86; P=.029; B-ref) and persisted for the rest of ethnicity. Patients diagnosed in NE were independently more likely to undergo surgery as compared to those in other regions (aOR: 1.25; P<.001); black individuals were less likely to undergo surgery as compared to whites, Asians, and Hispanics (P<.05 for all). Overall, a diagnosis of gastric cancer in the NE region was independently associated with superior GCS (HR=0.85; P<.001) (Table 1). Among patients who underwent surgery, those in the NE (HR=0.85; P=.001) exhibited superior GCS, but poor GCS in SO (HR=1.17; P=.001; West-ref). AS who underwent surgical intervention demonstrated superior GCS as compared to all other ethnic groups (HR=0.76; P<.001). Conclusion: There is significant difference in treatment and survival for GAC based on geographic region and race/ethnicity. Adherence to treatment guidelines and recommendations is essential to optimize outcomes for all patients.