Objective <p>The purpose of this study was to assess the benefits and safety of combining endoscopic interventional therapy with surgery in patients with primary tracheal cancer.</p> Patients and methods <p>This single-center retrospective cohort study included 39 patients with primary tracheal malignancies treated between January 2015 and August 2020. They were divided into a surgery-only group (Group A, <i>n</i> = 21) and a surgery plus endoscopic therapy group (Group B, <i>n</i> = 18). The primary endpoints were progression-free survival (PFS) and 5-year survival rate. Participants were followed up every three months, which included CT scans and assessments of treatment efficacy. Multivariate Cox regression models were employed to adjust for potential confounding factors.</p> Results <p>Adenoid cystic carcinoma (ACC) was the predominant histology in the entire cohort (64.1%). Median PFS was significantly longer in the combined therapy group compared to the surgery-only group (55.05 months vs. 35.8 months, <i>P</i> = 0.0276). In the subgroup analysis for ACC, the combination therapy group consistently showed a trend toward superior outcomes, though the differences did not reach statistical significance. The 5-year survival rates were 66.7% and 57.1% in the combined therapy and surgery-only groups, respectively. All treatment-related adverse events were mild to moderate, with no serious adverse events reported.</p> Conclusion <p>Surgery combined with endoscopic intervention significantly improves PFS in patients with primary tracheal carcinoma and shows a trend toward superior 5-year survival rate without increasing severe toxicity. This represents a safe and effective treatment strategy.</p>