Malignant colorectal polyps (MCP) are commonly encountered in clinical practice. When feasible, these polyps are often treated by endoscopic resection, but the outcome of endoscopic treatment compared to surgical resection is not known. Aim: To analyze outcomes in terms of cancer-free survival in patients with MCP based on endoscopic vs. surgical resection. Methods: The National Cancer Institute's Surveillance, Epidemiology and End-Results database of was searched to identify patients age >50 years with a first primary colorectal cancer. Specific ICD-O-9 histology codes were used to select only those patients with MCP diagnosed between 1998 and 2003. Only Stage 0 and stage I cancers by modified AJCC criteria were included. Data on demographic features, polyp characteristics (size, histology, depth of invasion), types of treatment received (endoscopic vs. surgical resection) and colorectal cancer specific mortality were analyzed. A Cox proportional hazards model was constructed to assess the impact of types of treatment received on cancer-free survival. Results: A total of 8,221 patients were identified with MCP. Only a minority (n = 581, 7.1%) were managed by endoscopic resection (Group A) with the rest managed by surgical resection (partial or hemi-colectomy, Group B). Table compares different variables between the two groups. In the Cox model, the relative hazard (RH) for colorectal-cancer specific mortality in group A was not different than that in group B (RH, 1.62; 95% CI, 0.69 -3.76). Variables significantly assocaited with survival were: mucosal (compared to submucosal) involvement only (RH, .54, 95% CI, 0.38-0.77); rectal site (compared to colonic; RH, 2.52, 95% CI, 1.64-3.88); tubular histology (compared to tubulovillous; RH, 0.67; 95% CI, 0.45-0.99); younger age at diagnosis (RH, 1.08 95% CI, 1.06-1.11. Conclusion: When feasible, patients with MCP managed with endoscopic resection have equivalent long term survival compared to those treated with surgical intervention. This is the first population based data that supports the effectiveness of endoscopic resection for managing these patients. Tabled 1 Group A n = 581 Group B n = 7640 P value Mean age(SD) in years 67.9 (11.5) 68 (9.9) 0.8 Men 61% 51.5% 0.001 White race 78.8% 83% 0.01 Site: Rectum 5.9% 11.2% 0.001 Histololgy: tubular 44.4% 37.8% 0.01 Size >2 cm in size 15% 36.4% 0.0001 Depth of invasion: submucosal 14.1% 38.5% < 0.001 Median colorectal cancer free survival (months)- Kaplan Meier estimate 56 70 0.23 (log-rank test) Open table in a new tab