Hypopharyngeal cancer has the following biological characteristics: insidious onset, latent growth, early appearance of lymph node metastasis, etc. Because of these characteristics, the prognosis of the disease is often poor. According to the anatomical location of the primary site, hypopharyngeal cancer is generally divided into three types: pear-shaped fossa cancer, posterior cricoid region cancer and posterior pharyngeal wall cancer. Among them, early stage carcinoma of the pear-shaped fossa and carcinoma of the posterior pharyngeal wall have a relatively good prognosis. In addition to the ease of complete resection, another important reason is that it is easier to preserve the function of the larynx during surgery. As we know, the main functions of the larynx are articulation, breathing, and swallowing protection. The loss of these functions, which are essential for patients to maintain normal daily life, will undoubtedly seriously affect the quality of life of patients. For the treatment of hypopharyngeal cancer, surgery-based comprehensive treatment is mostly recommended. How to protect or repair the function of larynx during surgery is the main challenge for head and neck surgeons. For early stage carcinoma of the posterior pharyngeal wall and pear-shaped fossa, the tumor can be removed with a small resection, and the structure and function of the larynx can be well preserved without much repair. However, for more advanced tumors with large lesions, it is more difficult to preserve laryngeal function. Even if the lesion does not invade the larynx, if it invades the tip of the pyriform fossa or even the entrance of the esophagus, total laryngectomy is often performed to reconstruct the esophagus to ensure that the patient can eat through the mouth. With the change of treatment philosophy and the improvement of surgical techniques, the technique has now been significantly improved. For these cases, esophageal reconstruction is generally chosen from free and empty fields instead of muscle and skin flaps, which were often used in the past. Due to the improved vascular microsurgery techniques, the success rate of the procedure is high. However, with preserved larynx, this repair is still more difficult and the chance of postoperative failure is not small. Even with the risk of failure, it is worthwhile to keep trying new techniques in order to preserve laryngeal function and improve the quality of patient survival. Here, we will specifically introduce posterior cricothyroidal carcinoma. This is a special type of hypopharyngeal cancer, which is not rare clinically, but has a poor prognosis. Since the cricoid cartilage is an important part of the laryngeal scaffold, tumors in this area can easily involve the larynx, and it is difficult to preserve the structure and function of the larynx in most cases. However, if the tumor invasion is more limited, a small local excision can be attempted, which can preserve the function of the larynx better. We have done some cases in clinical practice with good results. Finally, we emphasize that the treatment of any disease is not one-size-fits-all, and we need to analyze the patient’s situation specifically and develop an appropriate treatment plan. It is the gold standard to measure the reasonableness of our treatment, and it is our goal to keep patients alive and well. According to the current opinion of most experts, the treatment of hypopharyngeal cancer should follow the principle of comprehensive treatment, which generally adopts surgery plus radiotherapy, and sometimes combined with molecular biology treatment. The principle of surgery is to preserve the function of the larynx while removing the tumor.