Objective To compare the difference of clinicopathological characteristics of endoscopic submucosal dissection (ESD) and surgery of early gastric cancer patients, and to investigate the difference of the absolute and expanded criteria for ESD, so as to provide a basis for choosing the best treatment for early gastric cancer. Methods The clinicopathological data of 484 early gastric cancer lesions in Jiang Su Provincial Hospital were prospectively observed .Among them, 162 patients (163lesions) treated with ESD as the observation group, and 322patients (332lesions) treated with surgery as the control group. Results ①Multivariate analysis showed that endoscopic forceps biopsy with carcinoma, flat/depressed type, ulcer, and submucosal invasion were independent risk factors for the selection of surgery(hazard ratio=4.433，2.413，3.510，43.701，95%confidence interval: 1.315-14.941，0.985-5.912，1.276-9.655，15.565-122.692，P<0.05 ). ② Of the ESD group, the overall accuracy of absolute/expanded indications for treatment criteria was 93.7% (153/163). The pathology of 10 lesions met the surgical criteria were undifferentiated. In the ESD group, 14 lesions were undifferentiated, and 2 of the 4 lesions met expanded criteria of curative resection.③Multivariate analysis showed that tumor location , tumor size , depth of invasion , and lymphovascular invasion were independent risk factors for lymph node metastasis(hazard ratio=4.433，2.413，3.510，43.701，95% confidence interval: 1.315-14.941，0.985-5.912，1.276-9.655，15.565-122.692，P<0.05 ).④ In the surgical group, the lymph node metastasis rate of surgery criteria ,absolute criteria and expanded criteria were 32.21%, 1.96% and 3.3%, respectively. There was no statistically significant difference in lymph node metastasis rate between the absolute criteria and expanded criteria(F=0.428,P=0.51). Conclusions 1.In the choice of treatment methods of early gastric cancer, endoscopic forceps biopsy with carcinoma, flat/depressed type, ulcer and submucosal invasion were the independent risk factors for surgery. However there still many patients who meet the endoscopic resection criteria, especially those meet expanded criteria, endoscopic forceps biopsy with carcinoma, and flat/depressed type of early gastric cancer choose surgery. 2.The tumor located in the middle-third of the stomach, the tumor size>2cm, submucosal invasion and lymphovascular invasion were independent risk factors for lymph node metastasis. 3.There was no statistically significant difference in lymph node metastasis between the absolute criteria and expanded criteria . However, the accuracy of clinical selection of undifferentiated early cancer in the expanded indications was lower, so ESD is suitable for patients with differentiated indications in expanded criteria.