Background: Lymphovascular invasion (LVI) is associated with the risk of lymph node metastasis (LNM) and poor survival in gastric cancer patients. However, it is unclear whether LVI is a noncurative criteria component in all patients. We evaluated the risk factors of LNM in LVI-positive early gastric cancer (EGC) patients and identified a subgroup with a negligible LNM risk to assess the feasibility of endoscopic resection in these patients. Methods: The clinicopathologic and survival data of patients undergoing surgery for gastric cancer were reviewed; LVI-positive EGC patients were selected. Logistic regression analysis was used to test the associations of potential risk factors with LNM; Kaplan-Meier analysis was used to compare survival curves. Results: LVI was detected in 1,243 (15.5%) patients. In the multivariate logistic analysis, larger tumor size (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.16-1.31; P < 0.001), presence of ulcer (OR, 1.80; 95% CI, 1.15-2.82, P = 0.010), undifferentiated histology (OR, 1.64; 95% CI, 1.25-2.16; P < 0.001), submucosal invasion (OR, 2.28, 95% CI, 1.38-3.76, P = 0.001), middle (OR, 2.12; 95% CI, 1.26-3.55, P = 0.004) or lower third location (OR, 2.28; 95% CI, 1.32-3.60, P = 0.002), and younger age (OR, 0.98; 95% CI, 0.97-0.99; P = 0.002) independently predicted LNM in LVI-positive EGC patients. LVI-positive patients fulfilling the absolute endoscopic resection criteria did not have LNM, and there was no significant difference in the overall (P = 0.928) and disease-specific survival (P = 0.821) between these patients and those with LVI-negative EGC. Conclusions: Additional surgery after endoscopic resection might be unnecessary in LVI-positive patients meeting the absolute criteria for endoscopic resection.