Objective To evaluate the safety, effectiveness and long-term survival of endoscopic submucosal dissection (ESD) for the treatment of colorectal precancerous lesions and early cancer in the elderly over 80 years. Methods The clinical data of colorectal mucosal lesions treated by ESD from January 2007 to December 2014 in the Endoscopy Center of Zhongshan Hospital, Fudan University were retrospectively analyzed and a total of 721 patients with 778 lesions were included in this study. These patients stratified by age: the super-elderly group (≥80 years, 55 patients，7.6%) and the non-elderly group (＜80 years, 666 patients，92.4%). The outcomes of ESD, complication rate, pathological characteristics, and long-term survival were compared between the two groups. Results The rate of chronic concomitant diseases in the super-elderly group was significantly higher than that in the non-elderly group [54.5% (30/55) vs 31.5% (210/666), P<0.001], and the other baseline characteristics were not statistically significant (P>0.05). In addition, there were no statistically significant in the complete resection rate [93.1%(54/58) vs. 95.3%(686/720)], the R0 resection rate [89.7% (52/58)vs. 93.2% (671/720)], the curative resection rate [84.5% (49/58)vs. 90.3% (650/720)], the complications rate [5.5% (3/55)vs. 2.7%(18/666)], or the median hospitalization period (2.98 days vs. 2.54 days) between two groups. The 3-year overall survival rates of the super-elderly group and non-elderly group were 95.8% and 98.0%, respectively, and the 5-year overall survival rates were 85.1% and 97.4%, respectively. Conclusion Colorectal ESD is a safe and effective treatment for elderly patients (age ≥80 years) despite a significantly higher rate of chronic concomitant diseases than that in the non-elderly patients.