Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Oncol. Oct 15, 2026; 18(10): 123261
Published online Oct 15, 2026. doi: 10.4251/wjgo.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, 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: 117 Days and 20.8 Hours
Revised: June 18, 2026
Accepted: June 30, 2026
Published online: October 15, 2026
Processing time: 117 Days and 20.8 Hours
Core Tip
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.