OBJECTIVE To evaluate predictive factors for local control, larynx preservation and overall survival in patients with early laryngeal cancer, who were treated with endoscopic transoral CO2 laser microsurgery. BACKGROUND Transoral laser microsurgery (TLM) is the treatment of choice for early laryngeal cancer. The current study aimed to assess the outcomes and validity of carbon dioxide (CO2) laser microsurgery in patients with early larynx cancer and to determine predictors for outcomes. METHODS A retrospective study included all patients who were treated with laser microsurgery, in the Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, between the years 2009-2016. We evaluated outcomes according to local control, margin status, larynx preservation, and overall survival. Cordectomy types I-V were classified by the European Laryngological Society (ELS). RESULTS Laser microsurgery was performed in 74 patients with early laryngeal cancer, mean age 68.2±10.4 years, M: F 65:9, mean follow-up 58±28 months. Seventy-three percent (73%) were smokers. Primary tumor location was glottic in 68 patients (92%), supraglottic (5 patients - 7%), and subglottic (1 patient - 1%). Tumor stage was as follows: Tis: 18 patients (24%), T1a: 35 patients (47%), T1b:10 patients (14%) and T2: 11 patients (15%). In 72 patients (97%), margins were taken from the patient side, 64% (46 patients) had negative margins, whereas 26 patients (36%) had positive margins. Patients with positive margins had either further laser surgery (19%), or radiotherapy (14%). Two patients were not treated for positive margins, both had recurrent disease in a mean follow-up of 26 months, and both had total laryngectomy. Five years local control rate (LCR) stratified by stage was as follows: Tis-81.5%, T1a- 88%, T1b-100% and T2 - 58% (NS). Overall 5-year local control rate (LCR) was 83%, with no significant difference between patients with positive or negative margins. Overall 5-year survival was 87% and organ preservation rate was 93. CONCLUSIONS Laser microsurgery provides an excellent rate of disease free/overall survival for early laryngeal cancer and has a valuable role in organ preservation. No significant differences were found in LRC and overall survival between patients with positive margins compared to patients with negative margins, most probably due to immediate further intervention in patients with positive margins.