Xia MT, Zhou Q, Han H, Zhang D, Fan X. Lymph node metastasis in early gastric cancer: A review of risk stratification and surgical decision-making. World J Gastrointest Oncol 2026; 18(10): 123261 [DOI: 10.4251/wjgo.123261]
Corresponding Author of This Article
Xin Fan, MD, Chief Physician, Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Jingkou District, Zhenjiang 212000, Jiangsu Province, China. drfanxin@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Xia MT, Zhou Q, Han H, Zhang D, Fan X. Lymph node metastasis in early gastric cancer: A review of risk stratification and surgical decision-making. World J Gastrointest Oncol 2026; 18(10): 123261 [DOI: 10.4251/wjgo.123261]
World J Gastrointest Oncol. Oct 15, 2026; 18(10): 123261 Published online Oct 15, 2026. doi: 10.4251/wjgo.123261
Lymph node metastasis in early gastric cancer: A review of risk stratification and surgical decision-making
Min-Tian Xia, Quan Zhou, He Han, Dong Zhang, Xin Fan
Min-Tian Xia, Quan Zhou, He Han, Xin Fan, Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
Dong Zhang, Department of General Surgery, The First People’s Hospital of Siyang County, Suqian 223700, Jiangsu Province, China
Co-corresponding authors: Dong Zhang and Xin Fan.
Author contributions: Xia MT designed the study; Fan X and Zhang D were responsible for the revising and updating the initial draft of the manuscript, as they are co-corresponding authors; Xia MT, Zhou Q, Han H, authored the initial draft; Xia MT and Fan X performed data visualization; all authors contributed to editing, and agreed to the published version of the manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by Jiangsu Commission of Health, No. LKZ2023012; Zhenjiang Gastrointestinal Tumor Clinical Key Laboratory, No. SS2023011; New Technology and New Programs of Jiangsu University Hospital, No. xjs2024201; and Science and Technology Planning Project of Zhenjiang City, No. SH2025001.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Xin Fan, MD, Chief Physician, Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Jingkou District, Zhenjiang 212000, Jiangsu Province, China. drfanxin@163.com
Received: May 22, 2026 Revised: June 18, 2026 Accepted: June 30, 2026 Published online: October 15, 2026 Processing time: 118 Days and 19 Hours
Abstract
Early gastric cancer usually has a favorable prognosis, and endoscopic submucosal dissection allows many low-risk patients to avoid invasive surgery. This changes, however, when lymph node metastasis occurs; in these patients, gastrectomy with lymph node dissection is often required, which results in greater surgical trauma and a higher risk of postoperative functional impairment. However, preoperative assessment of lymph node metastasis in early gastric cancer remains challenging. Current diagnostic approaches provide useful information, yet no single method can reliably exclude small or occult nodal metastases. Therefore, this review focuses on the risk assessment of lymph node metastasis as a central issue in early gastric cancer. It discusses the biological basis of nodal spread, the limits of current diagnostic strategies, and the influence of these uncertainties on treatment selection. An integrated use of clinicopathological, imaging, and molecular information may support more individualized management of early gastric cancer.
Core Tip: Lymph node metastasis remains the central factor guiding treatment selection in early gastric cancer, but its prediction before treatment is still unreliable. This review summarizes the biological basis of lymph node metastasis, including epithelial-mesenchymal transition, lymphangiogenesis, and immune regulation, and evaluates current diagnostic approaches such as imaging, sentinel lymph node mapping, biomarkers, and artificial intelligence. The main message is that no single method can exclude lymph node metastasis with sufficient confidence. Integrated risk stratification using clinical, imaging, and molecular information is needed to support individualized treatment decisions in early gastric cancer.
