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From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St. Louis, Missouri. Forty-two or 9.4% were completion laryngectomies. Completion laryngectomy is defined as the removal of the remaining larynx following an antecedent partial laryngectomy. These 42 cases are retrospectively analyzed in regards to original conservation surgery, clinical presentation, histopathology and salvage rate. The most common indications for completion laryngectomy were: 1) local recurrence, 2) local recurrence with associated severe upper respiratory obstruction, and 3) fistula control. The overall salvage rate following completion laryngectomy was 55% (23 patients). The highest rate was in patients with previous hemilaryngectomy (69%), followed by subtotal supraglottic laryngectomy (44%), and partial laryngopharyngectomy (14%). There is a high incidence of stomal occurrences (24% or 10 patients) associated with completion laryngectomy, particularly in patients with antecedent hemilaryngectomy. Most indications for completion laryngectomy present early, however, all patients must be carefully followed. Both the patient and the otolaryngologist must be ever vigilant following conservation surgery.