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Gastric cancer remains a major cause of cancer mortality worldwide, particularly in middle-income countries, where late diagnosis is frequent and information on its economic impact is limited. We evaluated survival outcomes and direct healthcare costs of adult patients with gastric cancer treated between 2019 and 2024 at Hospital Universitario Mayor Méderi, a tertiary referral hospital in Bogotá, Colombia, using routinely collected clinical and administrative data from a tertiary referral hospital. Overall survival and healthcare resource utilization were described, and cumulative direct medical costs over 5 years were estimated in thousands (k) of 2023 international dollars (Int$). A total of 616 adult patients with gastric cancer were identified in hospital records during the study period. Of these, 388 patients (63.0%) met the eligibility criteria and were included in the final analytic sample, whereas 228 patients (37.0%) were excluded according to the predefined exclusion criteria. The median age was 65 years [interquartile range (IQR): 57-73]; 36.9% women). Using Tumor-Node-Metastasis staging (TNM: tumor extent, regional lymph node involvement, and distant metastasis) recorded in medical charts, 36.3% had stage III and 34.8% stage IV disease. Initial treatment intent was curative in 46.6% and palliative in 53.4%. The estimated cumulative mean direct cost was Int$ 89.3 k (95% CI: 75.9 k-102.8 k) at 2 years and Int$ 161.2 k (95% CI: 92.0 k-230.4 k) at 5 years. Median overall survival was 30.7 months (95% CI: 22.7-38.7), and the estimated 5-year survival probability was 40.0%; it was 45.5% for stage III disease and 12.5% for stage IV disease. Gastric cancer imposes both high mortality and substantial economic burden on the healthcare system, largely determined by the clinical stage at diagnosis. These findings highlight the potential population-level and financial benefits of strategies aimed at earlier detection and timely access to oncologic care in middle-income countries.