Total laryngectomy in advanced laryngeal neoplasma T4aBackground: In Chile a signifi cant number of patients is presented with advanced laryngeal cancer at diagnosis with poor prognosis and less than 50% survival at 5 years. Nowadays choosing the organ sparing treatment, but in selected cases total laryngectomy is a valid treatment option. Aim: To present the results obtained with the extended total laryngectomy in patients with advanced laryngeal carcinoma. Patients and Methods: Retrospective analysis of all patients with advanced laryngeal carcinoma T4a underwent total extended laryngectomy at our center between 2007-2010. Results: 18 patients, a woman, a median age 64 years (range, 50-82), they were studied and etapifi ed with Rhino-Laryngo-Fibrescope Olympus© and CT. Seven patients underwent emergency tracheostomy. All patients underwent total extended laryngectomy with primary pharyngeal closure. The median tumor size was 4.3cm. In 17 patients R0 was achieved. Postoperative complication was presented in one patient with a pharyngocutaneous fi stula. Thirteen patients were sent to radiotherapy. After a follow-up of 17 months (range, 2-55): one, two and three years of survival was 88.8%, 50% and 50% respectively. Conclusion: In the serie, extended total laryngectomy is a good therapeutic alternative in patients with advanced laryngeal carcinoma, with low surgical morbidity, short hospital stay and favorable survival.