Endoscopic treatment vs surgery for T1-stage colorectal cancer: a real-world retrospective cohort study

Endoscopic treatment is widely used for T1 colorectal cancer, yet there are limited studies that compare the survival outcomes of patients treated with endoscopy and surgery. This study utilized the data from the Surveillance, Epidemiology, and End Results database to evaluate the long-term survival of the two treatment regimens in America. The analysis of T1-stage colorectal cancer patients from 2000 to 2018 was assessed using Kaplan-Meier analyses and log-rank tests. Accounting for the imbalance in covariate distribution between the two groups, a propensity score matching method was employed, followed by a comparison of survival outcomes. Of the 4,834 patients included in this study, 4,116 underwent surgery, while 718 underwent endoscopic procedures. Overall survival did not significantly differ between the groups prior to the use of the propensity score matching method, but the surgery group's cancer-specific survival was noticeably higher (<italic>p</italic> = 0.0022). Following propensity score matching, there were no discernible variations in overall or cancer-specific survival. Subgroup analysis indicated that older patients, males, and those with higher histological grades had significantly better cancer-specific survival outcomes with surgery compared to endoscopic treatment. According to data from the American population, there was no variation in long-term survival rates for T1-stage colorectal cancer between the two groups.