Objective To evaluate the outcomes of early gastric cardiac cancer with submucosal invasion treated with endoscopic submucosal dissection (ESD). Methods A retrospective study was performed on data of 147 ESD-resected early gastric cardiac cancer with submucosal invasion in consecutive 146 patients over the period between January 2011 and June 2018 at Affiliated Drum Tower Hospital of Nanjing University Medical School (136 patients) and Gaochun People""s Hospital (10 patients). Short-term outcome results (en bloc, complete, and curative resection rates) and post-resection patient survival （5-year overall survival rate and disease-specific survival rate）were investigated. Results The en bloc, complete, and curative resection rates were 100.0% (147/147), 84.4% (124/147), and 38.8% (57/147), respectively. In the 75 tumors with SM1 (depth of invasion<500 μm), 57 were expanded indication with curative resection and 18 others were beyond indication with non-curative resection. All the 72 tumors with SM2 (depth of invasion≥500 μm) underwent non-curative resection beyond indication. The median follow-up period was 43 months (2-101 months), and 133 patients were followed up. The 5-year overall survival rate was 90.9% for the cohort, not significantly different between expanded indication group (95.7%) and beyond indication group (88.5%) (P=0.48). The difference in the 5-year disease-specific survival rate was not significant between expanded indication group (100.0%) and beyond indication group (97.5%) (P=0.26). Conclusion ESD is an effective treatment option with favorable outcomes for early gastric cardiac cancer with submucosal invasion in expanded indication. Patients in the beyond indication show favorable clinical outcomes but need to be carefully followed up after ESD.