Objective:To investigate the clinicopathological characteristics of gastric carcinomas of less than 2 cm in diameter and situation of lymph node metastasis. Methods:The data from 453 patients surgically treated for gastric cancer less than 2 cm in diameter between 1998 and 2007 were reviewed retrospectively. The clinicopathological variables inculding age,gender,histological type,morpliologieal type,size,location,depth of invasion and tumor thrombus which were associated with lymph node metastasis,were evaluated. The results of retrospective analysis of clinicopathological data of 198 patients with advanced cancer were compared with those of 255 patients with early cancer. Univariate and multivariate analyses of the data were performed to evaluate the clinicopathological variables associated with lymph node metastasis. Results:A significant difference was observed on the tumor size(1.31 ± 0.57 cm vs 1.70 ± 0.47 cm,P < 0.0001),the incidence of lymph node metastasis(11.8% vs 46.0%,P=0.0001)and the presence of vascular or lymphatic invasion(3.5% vs 7.6%,P=0.0341)in the two groups. The histological classification,tumor size,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion showed a positive correlation with the rate of lymph node metastasis by univariate analysis. Multivariate analyses revealed that histological classification,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For early gastric cancer,tumor size,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion were the risk factors for lymph node metastasis. For advanced cancer,the histological classification and depth of gastric carcinoma infiltration were the risk factors for lymph node metastasis. Conclusion:Histological classification,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in gastric cancer less than 2 cm in diameter. Minimal invasive treatment,such as laparoscopic gastrectomy,may be a possible treatment for highly selective patients.