Recurrent LSCC treatment represents a challenge for surgeons. A correct re-staging of the recurrence is an essential pre-requisite for the success of the salvage treatment. The standard treatment for recurrent LSCC after the failure of primary non-surgical protocols/primary transoral laser microsurgery is the total laryngectomy (TL). The correct indications for a conservative surgery for salvage, however, still represent a matter of debate. OPHLs can be considered for salvage after RT/TLM failure in selected patients when proper selection criteria are adopted. Indications and contraindications are the same as partial laryngectomies performed for primary LSCC.