Better endoscopic, CT and MR diagnostics of laryngeal cancer significantly improved the local assessment of the spread of cancer, especially the volume and intensity of the affected structures of the larynx. This is the basis for a better selection of patients for a certain method of treatment, especially in advanced cancers, which represent a heterogeneous group, where some respond better to surgery and others to organ preservation therapy. In the previous period, the very popular non-selective organ preservation with induction/competitive chemoradiotherapy did not give the expected results with a decrease in overall survival, worse functional results and worse quality of life. In the light of modern knowledge, the indication for chemoradiotherapy is reserved for patients with a small volume of cancer, preserved airway, good swallowing function without the need for a tracheostomy or gastrostomy or tube, limited cartilage destruction and patients who can tolerate the toxicity of chemoradiotherapy related to radiotherapy.   For open surgery, it is very important to assess the degree of involvement of the paraglottic, preepiglottic space, cartilage infiltration, and spread to extralaryngeal tissues. The paraglottic space is divided into anterior and posterior compartments, so advanced carcinomas involving the anterior compartment can be treated with open laryngeal reconstructive surgery, while advanced posterior compartment carcinomas are better controlled by total laryngectomy. Reconstructive surgery involves the application of one of the horizontal laryngectomies, supraglottic, supracricoid or supratracheal. Reconstructive surgery is indicated in patients younger than ≤70 years, who are neurologically healthy and can master the procedure of postoperative swallowing rehabilitation, with good cardiopulmonary function, a tumor that does not spread too far posteriorly and/or massive involvement and ankylosis of the cricoarytenoid joint.  N status affects the choice of therapy, so a low N status favors the application of surgical therapy, and a high one favors the application of organ preservation. 

Good patient selection and individual application of an adequate treatment modality is the key to achieving good oncological disease control, good functional results and good quality of life.