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Current Japanese guidelines define indications and curability criteria for endoscopic resection (ER) irrespective of age. Consequently, gastrectomy with lymphadenectomy remains the standard treatment for EGC that exceeds established absolute and expanded ER indications or is classified as endoscopic curability (eCura) C\u20102 after ER. However, given the heterogeneity of metastatic risk and patient characteristics, uniform recommendation of gastrectomy may result in overtreatment in elderly patients. Nationwide registry data on patients undergoing gastrectomy have demonstrated that overall prognosis becomes increasingly limited and postoperative mortality rises with age, especially in men aged \u2265\u200975\u2009years and women aged \u2265\u200980\u2009years. These findings highlight the need to reconsider ER indications and post\u2010resection management in elderly patients based on estimated lymph node metastasis (LNM) risk, operative mortality, and life expectancy. Recent studies suggest that expanding ER indications and redefining curability criteria in elderly patients using a higher acceptable LNM risk threshold, such as 10%, may represent a rational risk\u2010adapted strategy. This concept is currently being evaluated in the multicenter phase III confirmatory trial conducted by the Japan Clinical Oncology Group (JCOG1902). Importantly, long\u2010term outcomes in elderly patients with EGC are influenced by non\u2013gastric cancer deaths. Therefore, management strategies should integrate tumor\u2010related risk with patient\u2010related factors, including comorbidities, nutritional status, frailty, and competing mortality risks, to achieve individualized and clinically meaningful care in this expanding population.<\/jats:p>","DOI":"10.1111\/den.70257","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:14:52Z","timestamp":1786425292000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Indications and Curability Criteria for Endoscopic Resection of Early Gastric Cancer in Elderly Patients: Current Standards and Future Perspectives"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6253-6896","authenticated-orcid":false,"given":"Masau","family":"Sekiguchi","sequence":"first","affiliation":[{"name":"Division of Screening Technology National Cancer Center Institute for Cancer 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