Abstract: To evaluate the effect of primary surgical and non-surgical treatment on the survival of advanced laryngeal squamous cell carcinoma ( LSCC ) patients. Methods: From 1990 to 2005, 312 patients with advanced LSCC and hospitalized at the Cancer Center of Sun Yat-Sen University were reviewed retrospectively. A total of 238 ( 76.3% ) received surgical treatment, while 74 ( 23.7% ) received non-surgical treatment. The 5-year accumulative survival rates for both groups were estimated. Then, the 5-year accumulative survival rates of patients with LSCC at stages III or IV were compared. Results: The overall 5-year accumulative survival rate was 50.1%. The 5-year accumulative survival rates of the surgical and non-surgical groups were 55.6% and 30.3% ( P < 0.001 ), respectively. The 5-year accumulative survival rates of both groups with stage III disease were similar ( 65.4% vs. 47.5%, P = 0.222 ), and no difference was found between them. However, the 5-year accumulative survival rate of the surgical group with stage IV disease was significantly better that of the non-surgical group with stage IV disease ( 44.7% vs. 21.5%, P = 0.013 ). A significant difference between these groups was also found. Conclusion: The results of the present study demonstrate that the survival rate of the surgical group is better than that of the non-surgical group in patients with stage IV laryngeal cancer, and, specifically, T4 primary tumors. When the cervical lymph node is negative (N0), treatment is the only factor that influences the survival rate of patients with T4 tumors.