To evaluate survival outcomes of radiotherapy versus surgical resection in the treatment of early stage laryngeal cancer. Data was extracted from the Surveillance, Epidemiology, and End Results 18 Database. The cohort included 5,301 patients diagnosed with stages I and II laryngeal squamous cell carcinoma between 1992 and 2009, treated with either surgical therapy or radiotherapy. Patients who received surgical therapy had better overall survival (OS) than patients who received radiation therapy (p<0.001). The difference in OS between treatment groups remained after stratification by stage (p<0.001 for Stage I; p=0.03 for Stage II) and subsite (p<0.001). On multivariable analysis, the radiotherapy group had worse OS (hazard ratio (HR)=1.29). Patients with early-stage laryngeal cancer treated with surgical therapy have better survival outcomes than patients treated with non-surgical therapy.