Endoscopic CO2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly reported advantages of ELS are good oncologic results with low incidence of complications. Although less common if compared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood transfusion, or revision surgery. We present our institutional experience, discuss the possible complications of ELS for laryngeal cancer, and outline the concepts of their treatment, with comprehensive literature review. Complications are more frequent following the treatment of supraglottic as compared to glottic cancer. If compared with open surgery, ELS for laryngeal cancer is associated with a lower incidence of complications. Every surgeon performing ELS should comply with particular strategies to avoid complications in the first place, and have a clear concept of their management if they occur.