Abstract Background We performed a paired analysis to compare the therapeutic effect between the induction chemotherapy‐based organ‐preservation approach and immediate total laryngectomy in hypopharyngeal squamous cell carcinoma patients requiring total laryngectomy. Methods 351 patients who were treated with organ‐preservation approach were compared with 110 patients who were treated with total laryngectomy. The main measures and outcomes were progression‐free survival (PFS), overall survival (OS), and larynx function preservation survival (LFPS). Results No statistical difference was observed for 3‐, 5‐, and 10‐year PFS and OS in two groups. In the organ‐preservation group, the 3‐, 5‐, and 10‐year LFPS was 30.7%, 23.3%, and 16.6%, respectively. The LFPS of Stage III > Stage IV, N0 > N1 > N2 > N3, T2 > T3 > T4, CR > PR > SD > PD patients (all p values