Objectives: The optimal treatment for stage T1 glottis squamous cell carcinoma remains controversial. We compared the oncological and vocal outcomes of patients who received endoscopic surgery with radiofrequency ablation (RFA) or open surgery. Design&Setting&Participants: Data were retrospectively collected for 93 patients who received primary treatment by RFA (n = 65) or open surgery (n = 28) from 2008 to 2014. Main outcome measures:Their characteristics were compared using the chi-square test. The 5-year disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Prognostic factors were assessed by univariate analysis using the log-rank test and by multivariate analysis using Cox models. Subjective vocal outcomes were evaluated by Voice Handicap Index-30 (VHI-30) questionnaire. The VHI scores of the two groups were compared using Mann-Whitney U test. Results and Conclusions:The 5-year DFS was 72.3%(47 / 65) for the RFA group and 92.9% (26 / 28) for open surgery group The open surgery group and a significantly better 5-year DFS (P=0.03), but the two groups had comparable OS (RFA: 86.2%; open surgery: 78.6%; P=0.26). Open surgery led to significantly worse voice quality (P<0.001). Among patients who received open surgery, those with involvement of the anterior commissure had higher total VHI scores (P=0.02).RFA and open surgery were both effective surgical treatments for stage T1 glottis squamous cell cancer. Open surgery was associated with a lower local recurrence rate but a worse VHI score. Among patients receiving open surgery, those with tumors involving the anterior commissure had poorer vocal outcomes.