AIM To evaluate endoscopic technologies in treatment of patients with colorectal cancer and severe comorbidities. MATERIAL AND METHODS Two groups of patients after endoscopic (group 1, n = 58) and open (group 2, n = 40) surgery were assessed. RESULTS Comorbidities were observed in 90.7% patients in group 1 and 83.3% patients in group 2 (p > 0.05). Mean comorbidity index was 6.9±0.3 (2-14) and 7.1±0.7 (2-18) in both groups respectively. Comorbidities ASA grade 3-4 were observed in 88.2% patients of group 1 had and in 71.4% patients of group 2 (p > 0.05). One patient of group 1 with intra-abdominal bleeding required conversion of surgical approach. In another case the conversion was due to technical difficulties during intestinal resection. Postoperative complications were noted in 2 patients (3.4%). There were no intraoperative complications in group 2. Postoperative complications were observed in two cases (5.0%). CONCLUSION Severe comorbidities do not impose serious restrictions on the choice of endoscopic approach in colorectal cancer patients.