Surgical resection offers better survival outcomes for poorly differentiated early gastric cancer.

• Surgical resection linked to better cancer-specific survival (CSS) and overall survival (OS) with hazard ratios of 0.61 and 0.56, respectively.
• Statistically significant differences in CSS and OS observed after propensity score matching (p-values 0.034 and 0.033).

Surgeons should favor surgical resection to align with guidelines and ensure optimal patient outcomes.