BACKGROUND: Liposarcomas involving the upper aerodigestive tract (UADT) are extremely rare. Consequently, consensus regarding the treatment approach and surveillance is not well established. METHODS: We present four cases of UADT liposarcoma. All patients presented with either dysphagia or respiratory difficulty and underwent endoscopic examination as part of their diagnostic workup. Surgical excision, either endoscopic or open resection, was performed for all patients. RESULTS: All patients had a pathologic diagnosis of well-differentiated liposarcoma without nodal or distant disease involvement. One patient underwent complete resection with no recurrences. Another patient experienced several recurrences, and his tumor ultimately underwent rapid disease progression and pathologic transformation into dedifferentiated liposarcoma, necessitating total laryngectomy. Of the two patients with positive surgical margins at their initial resections, one was lost to follow-up from our institution. The other three patients, including the second patient with positive margins, continue to follow up with endoscopic surveillance at our institution with no evidence of residual disease. CONCLUSIONS: UADT liposarcoma is a locally aggressive tumor that may frequently recur. Stringent surveillance is necessary to monitor disease progression, particularly if positive margins are noted during surgical excision. The role of adjuvant therapy has yet to be established.