OBJECTIVE To discuss the effects of clinico-pathological features on lymph node metastasis (LNM) in undifferentiated EGC (early gastric cancer), as well as identify the appropriate medical management. METHODS From January 1999 to June 2011, 352 patients were treated for undifferentiated EGC in our hospital. All patients had undergone gastrectomy with regional lymphadenectomy. We used univariate and multivariate analyses to determine the features associated with lymph node metastasis in patients with undifferentiated EGC. RESULTS Signet ring cell carcinoma (SRC) was more common in patients with undifferentiated EGC than other undifferentiated carcinoma (UDC). SRC had a tendency to be confined to the mucosa, with a smaller size than other UDC. The incidence of LNM for SRC was lower than that for other UDC. Multivariate analysis showed that LNM was associated with the sex, tumor size, depth of invasion,lymphovascular invasion, and histological type. CONCLUSION Complete endoscopic resection is suitable for SRCtype intramucosal EGC, which is less than 2 cm in diameter without lymphovascular invasion in the postoperative histological examination.