Most patients with laryngeal cancer need to undergo a tracheotomy. Only a small number of early-stage laryngeal cancer cases might consider temporarily avoiding a tracheotomy. If it's an early-stage vocal cord or glottic laryngeal cancer, especially in T1 cases, many might consider minimally invasive surgery under endoscopic support, which typically involves using a laser for surgical removal. After such procedures, the glottis is relatively wider, which reduces the likelihood of breathing difficulties or asphyxiation, and in these cases, a tracheotomy might temporarily not be necessary. If the lesion is extensive, categorized as middle to late-stage, or if there is a need for laryngotomy, all these situations require a tracheotomy to ensure effective breathing and prevent airway obstruction. Severe cases could lead to asphyxiation or even be life-threatening.