Lymph node metastasis in patients with early gastric cancer was evalua
ted prospectively to determine whether radical (D-2) lymphadenectomy i
s appropriate in such cases. Twenty-eight (18 per cent) of 156 patient
s having surgery for gastric cancer had early disease. Lymph node meta
stasis was found in 12 of the 28 patients. Metastasis was more likely
in submucosal than mucosal early gastric cancer (nine of 14 versus thr
ee of 14; P=0.024, Fisher's exact test). In two of three patients with
metastasis at the N-2 level, the N-1 nodes were entirely clear. This
study shows a higher incidence of lymph node metastasis than has been
reported previously in both the UK and Japan. The high incidence of ly
mph node metastasis in early gastric cancer supports the continuing us
e of radical lymphadenectomy in patients who are fit for such major.