Background: The effect of fundoplication, the most common antireflux operation, on the development of esophageal adenocarcinoma (EAC) caused by gastroesophageal reflux disease (GERD) remains controversial. Our aim was to investigate whether fundoplication has a protective role against EAC. Methods: Finnish Cancer Registry, Statistics Finland, and National Research and Development for Welfare and Health -audited Finnish national registers- provided the rate of fundoplication between 1987 and 2006 and all EACs diagnosed in Finland (population ca. 5 million) between 1980 and 2006. The hospital and outpatient records of EAC patients were evaluated. Results: The mean annual rate of fundoplication in Finland was 977. Of 1038 EACs, 57 had undergone fundoplication at mean age of 54.4 years (range 27-76): 42 men (74%), 15 female (26%). Mean age at the diagnosis of EAC was 65.6 (range 29-89). The mean time interval between fundoplication and EAC was 10.5 years (range 0-34). Before fundoplication 39 (68%) patients had had endoscopic esophagitis, including 24 with Barrett esophagus (1 high grade dysplasia). At the time of EAC diagnosis, objectively normal fundoplication was ascertained in 23 cases (40.4 %) and failed in 20 patients (35.1%). Of these 20, 17 (29.8%) were diagnosed at endoscopy and 3 at pH measurement. In 14 patients (24.5%) the postoperative condition of fundoplication could not be verified. Of these, 4 (7.0%) had symptoms of heartburn and/or regurgitation. Conclusions: Intention to treat GERD with antireflux surgery does not prevent from the development of EAC. EAC can arise also in patients with functional fundoplication. Although EAC can develop in preoperatively normal esophageal mucosa, patients with Barrett esophagus and endoscopic esophagitis seem to be at higher risk for EAC.