Background. Since the introduction of endoscopic laser surgery at our institution in 1996, 189 patients have been treated for T1 glottic carcinoma. Methods. Treatment allocation (radiotherapy vs laser surgery) and outcome were evaluated. Results. Fifty-one percent of T1a lesions were considered suitable for laser surgery. Sixteen percent of T1 a patients treated with laser surgery needed additional treatment because of positive resection margins. Overall local control and larynx preservation were 89% and 96%. Both were poorer in T1a patients with larger lesions treated with radiotherapy (local control 75% versus 89%, p = .05, larynx preservation 83% vs 100%, p = .001). Conclusion. Outcome for T1a patients selected for laser surgery is excellent. In patients with larger lesions treated with radiotherapy, outcome is inferior to patients selected for laser surgery, but also to that reported for (unselected) T1a carcinomas treated with radiotherapy in literature. Strategies to improve treatment results in patients deemed unsuitable for laser surgery should be designed.