Objective  To investigate clinicopathological features, risk of lymph node metastasis, and indications of endoscopic submucosal dissection (ESD) in young patients with intramucosal early gastric cancer (EGC).

  Methods  In total, 325 EGC patients who underwent radical gastrectomy and had complete clinicopathological data in Anhui Provincial Hospital from March 2009 to December 2016 were retrospectively evaluated. All patients were confirmed to have intramucosal cancer based on their postoperative pathology results. The patients were assigned into two groups according to their age: young group (≤40 years) and old group (>40 years). The clinicopathological features and safety of ESD in the youth group were analyzed.

  Results  Among all patients with intramucosal EGC, 30 (9.2%) were in the youth group. Intramucosal cancer in the youth group occurred predominantly in women, and the pathological types were mainly undifferentiated and mixed, which were more likely to metastasize to the lymph nodes. In the youth group, EGC patients with intramucosal differentiated type, who had ESD indications, had no risk of lymph node metastasis. However, the rate of lymph node metastasis was up to 25% in intramucosal undifferentiated-type EGC patients who had expanded ESD indications.

  Conclusions  Young patients with intramucosal EGC have poor pathological differentiation and strong invasiveness, and ESD may be considered for the treatment of differentiated intramucosal cancer.