Objective To investigate the differences of endoscopic surgery and traditional surgery for treatment of colon polyp canceration. Methods In this study, 131 patients, who underwent colonscopy in the Affiliated Hospital of Qingdao University from January 2005 to January 2017 and were pathologically diagnosed as adenomatous polyp with high-grade intraepithelial neoplasia or carcinoma, were retrospectively analyzed. They were divided into endoscopic group (80 cases) and surgical group (51 cases). Endoscopic treatment was provided for the patients in the endoscopy group, the patients in the surgery group received surgical resection. The diameter, location, morphology and pathological types of the polyps in the two groups were statistically analyzed; at the same time, complications, treatment cost, hospitalization time and fasting time were observed. Results The patients with smaller polyps (diameter ≤ 2 cm), pedicled polyps and precancerous polyps chose endoscopic treatment; those with larger polyps (diameter ≥ 3 cm), wide-base polyps and cancerous polyps usually chose surgical resection; there were statistical differences between the two groups. The treatment cost was lower, the hospitalization time and fasting time were shorter, the complications were fewer in the endoscopic group, with significant differences from the surgical group. Multiple factor logistic analysis revealed that treatment cost and fasting time of endoscopic treatment were obviously different from those of surgical treatment. Conclusions Compared with traditional surgery, endoscopy has the advantages of less trauma, fast recovery and lower cost in the treatment of early colorectal cancer. It is worth popularizing in clinic.