We aimed to evaluate factors influencing quality of life (QOL) after transoral laser microsurgery (TLM) of laryngeal cancer. Four hundred and one consecutive disease-free patients were evaluated 1 year after treatment using the University of Washington-QOL v4, the SF-12 (short form of SF-36), and a questionnaire about self-rated health status. The importance of age, gender, tumor location, tumor size, tumor stage, neck dissection and adjuvant treatment were evaluated. One year after TLM patients had a good QOL, with only 6 % of patients reporting a worsening in their health status. Radiation therapy (p = 0.000) and neck dissection (p = 0.000) were negative factors for disease-specific QOL, whereas age ≥ 70 (p = 0.01) was a positive independent factor for mental score of SF-12. Speech was negatively influenced by tumor size (p = 0.001) as was swallowing by age (p = 0.001) and postoperative radiation (p = 0.000). Patients treated with TLM present a good QOL 1 year after surgery. Radiation and neck dissection negatively impact QOL. Elderly patients cope better with their disabilities.