Lymph node metastases in early gastric cancer, when the East and the West come to terms

Endoscopic resection of early gastric cancer (EGC) is limited by the risk of lymph node metastasis (LNM). In general, resection of small (less than 2 cm) differentiated EGC which is limited to the mucosa is deemed safe due to negligible risk of lymph node metastasis. Expanding endoscopic resection beyond this criterion has been a matter of debate. In a land mark study by Gotoda et al., the risk of LNM for mucosal differentiated lesions without ulceration, irrespective of size, mucosal differentiated ulcerated lesions ≤2 cm, and poorly differentiated lesions ≤3 cm was 0% (1).