The hospital and office records of patients undergoing major surgery for cancer of the larynx and hypopharynx at the Washington University Medical Center, St. Louis from 1955 to 1972 were reviewed. Study parameters were correlated with the incidence of major complications and statistically analyzed to elucidate what factors contribute to increased complication rates. Abnormal margins of surgical resection were found to be significant in determining subsequent complication. Age, sex, race, site and stage of the primary tumor, and the presence of pre-treatment cervical lymph node fixation did not alter the rate of complications. Similarly, low dose preoperative irradiation, various forms of carotid artery protection, and surgical patholgic findings including the size of the tumor, number of positive cervical nodes and cellular characteristics of the tumor showed no significant effect on the rate of complications. Increased total complication rate was associated with an increased death rate. Common complications included wound infection, wound necrosis, salivary fistula, hemorrhage, and carotid artery catastrophe. Also considered were operative deaths and delayed fatal complications. The common causes and treatment of these complications are outlined and safeguards which have been valuable in a sizeable number of patients are discussed.