The prognosis after a gastrectomy for early gastric cancer (EGC) is favorable. Among 115 patients with early gastric cancer since 1983, 96 patients have received a radical gastrecomy (RG) and 19 have received a simple gastrectomy (SG). The cancer was confined to the mucosa in 47 cases and had invaded into the submucosa in 68 cases. Perigastric lymph nodes metastasis was observed in 17 patients (14.8%). The metastatic rate for mucosal cancer was 2.1% and that of submucosal cancer was 23.5% (p less than 0.005). Advanced nodal metastasis was occasionally visible in a few patients with submucosal cancer. The macroscopic pattern, size, primary site and differentiation of the cancer and the age and sex of the patients did not influence the rate of nodal metastasis. A follow-up study of 61 patients with EGC operated on before 1988 was carried out, the 5-year survival rate of RG was 92.9% and that of SG was 84.2% (p = 0.3109). The 5-year survival rate for mucosal cancer for RG was 100% and that for was 90.9% (p = 0.3048). The 5-year survival rate for submucosa] cancer for RG was 89.3% and that for SG was 75.0% (p = 0.0685). We suggest that RG be mandatory for EGC unless the depth of invasion is confined to the mucosa in the preoperative diagnosis, or if gross advanced metastasis is present to obtain more accurate postoperative staging and to achieve a curative resection. However, SG is still an alternative treatment for EGC if a patient's condition is poor or for extremely old patients.