Objective To investigate the overall prognosis of low-temperature plasma surgery for early laryngeal cancer, and to evaluate the influence of related risk factors on patients’ disease free survival (DFS), so as to analyze the factors affecting the surgical effect and summarize clinical experience.Methods Clinical data of 369 patients with early laryngeal cancer who received endoscopic low-temperature plasma surgery in our hospital from April 2013 to December 2020 with complete follow-up data were retrospectively analyzed. The follow-up period ranged from 32 to 124 months, with a median follow-up of 72 months. Statistical analysis was performed to obtain various oncology results, including DFS, overal survival (OS), local control and laryngeal preservation rates.Results A total of 70 patients recurred and 40 died. Overall 1-, 2-, and 5-year DFS for all patients were 89%(95%CI:86%-92%), 85%(95%CI:82-89%), and 80%(95%CI:76%-84%), respectively, and the median DFS was not reached. The 1-, 2-, and 5-year OS were 97%(95%CI:96%-99%), 92%(95%CI:89%-95%), and 89%(95%CI:85%-92%), respectively, with the median OS not reached. Anterior commissure invasion significantly affected DFS, but had no effect on OS. The 1-, 2- and 5-year DFS of ACI patients were 87%(95%CI:82-92%), 82%(95%CI:77%-88%) and 76%(95%CI:70%-82%), respectively. In non-invasive patients, 1-, 2- and 5-year DFS were 92%(95%CI:87%-96%), 89%(95%CI:84%-93%) and 85%(95%CI:79%-91%), respectively.Conclusion The efficacy of low-temperature plasma surgery is comparable to that of CO₂ laser surgery or radiotherapy alone. Anterior commissure invasion and postoperative incisal margin are also important factors affecting postoperative DFS, and the second plasma surgery is not contraindicated for patients with recurrence. Therefore, preoperative evaluation must be conducted accordingly, and only when it is confirmed that there is no obvious invasion of the lateral thyroid cartilage in the anterior commissure area and a negative incisal margin can be obtained before the treatment of plasma surgery is considered, can the patient obtain the optimal therapeutic effect.