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Background There are limited data on the role of laser-assisted surgery for early glottic cancer in elderly patients. Methods This retrospective study was conducted on a series of 130 consecutive cases of early glottic carcinoma occurring in elderly patients (>65 years old) treated with CO2 laser surgery. Results The overall and disease-specific survival rates were 87.7% and 99.2%, respectively. The rates of local disease control after primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 84.6%, 93.8%, and 96.9%, respectively. A shorter disease-free survival (DFS) was associated with the involvement of 1 or more specific laryngeal regions (arytenoids, ventricle, anterior commissure, vocal muscle, subglottis) ( p = .01) and the status of the surgical margins ( p = .002); on multivariate analysis, only the latter remained prognostically significant vis-à-vis the DFS ( p = .002). Conclusions Even in elderly patients with early glottic carcinoma, endoscopic laser surgery is an effective treatment. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]