Background/Aims: Surgical therapy of early gastric cancer(EGC) is usually cur;itive with more than 90% of a 5-year survival rate. However, there has been debates conceming adequate surgica1 techniques for treatment of the EGC especially regarding tbe extent of the lymph node(LN) dissection. In addition, with recent advances in diagnostic techniques, limited surgery or severa1 non-surgical methods have also been proposed in some selected cases, In this,tudy, we evaluated pattems of LN metastasis of EGC to formulate a treatment policy of EGC which fulfill both curability and ]ow treatment associated morbidity. Methods: This study was based on 219 cases of EGC during the 7 years from 1989 to 1995 in the Department of Surgery, Catholic University Medical College. Results: Thirty five patients(16.0%) had nodal metastasis with 11.9% and 4.1% of Nl and N2 LN involvement respectively. Incidence of LN metastasis in mucosal(m) cancer was 4.2%(N1:3.2%, N2:1.0%). In submucosal(sm) cancer, 24.8% had LN metastasis(N1:18.4%, N2:6.4%). No LN metastasis was noted in m-cancers no more less than 2cn in oiametere and sm-cancers less than 1cm in diameter. All four cases of m cancer with LN metastasis were greater than 2.5cm in diameter and moderate or poorly differentiated tubular adeno arcinomas. All 23 cases of sm-cancers with Nl LN metastasis were greater than 1.5cm in diamet<:r. Four lesions less than 2.5cm were exclusively a depressed type. All 8 cases of sm-cancers witti N2 LN metastasis were greater than 3cm in diameter. Conclusions: Sixteen percent of LN metasiasis in EGC justify the adoption of gastrectorny with LN dissection as a standard treatment mocality for EGC. D2 gastrectomy should be indicated in patients with >=3cm of depressed sm-cancer because of possible N2 node metastasis. However, concerning the quality of life after gastric resection, less aggressive approaches can be applied to selected cases. Indications of limited surgery for EGC were as followes: 1) endoscopic mucosal resection or laparoscopic wedge -esection for tbose patients with m-cancer <2cm, 2) laparoscopic wedge resection for well diff.rentiated m-cancer >=2cm or sm-cancer <1cm. (Korean J Gastroenterol 1997; 30:730-739)