OBJECTIVE To identify clinicopathological characteristics as predictive factors for recurrence in early gastric cancer (EGC), and to determine which lesions should be removed by gastrectomy by means other than endoscopic mucosal resection (EMR).METHODS Data from 249 patients with EGC were collected and the relationship between their clinicopathological characteristics and postoperative recurrence was retrospectively analyzed by univariate analysis.RESULTS Of the 249 patients after gastrectomy, 19 cases (7.6%)experienced a recurrence. The postoperative recurrence rate was 18.9%(7/37) in patients with lymph node metastasis, and 5.7%(12/212) in those without. Lymph node metastases were found to be significantly related to recurrence in EGC (P = 0.005).CONCLUSION Lymph node metastases were the only predictive factor for recurrence in EGC. However, this was not the determining factor for performing gastrectomy rather than EMR. Although after gastrectomy with lymphadenectomy of EGC, patients with lymph node metastasis should be considered as candidates for adjuvant treatment. For lymph-node metastatic EGCs, adjuvant therapy is recommended following gastrectomy with lymphadenectomy.