Induction of anesthesia and transoral and endotracheal intubation by the anesthesia colleagues and positioning of the patient by the surgeon. Placement of the McIVOR blade. Inspection of the oral cavity. This revealed a slightly hardened tonsil on the left side. The decision was made to perform a direct tumor tonsillectomy, including the anterior and posterior palatal arch. As part of the resection, a large safety margin is clearly maintained from the tonsil. Dissection from caudal to cranial, including fibers of the constrictor pharyngis medius muscle. The tonsil preparation is sent for intraoperative frozen section examination, which results in the diagnosis of a squamous cell carcinoma, forming a margin in the caudal area of the resectate. Therefore, resection in this region. Removal of three marginal samples (posterior palatal arch, anterior palatal arch, wound base) which were found to be tumor-free by the pathology colleagues. Thus, an R0 resection in the area of the left tonsil can be assumed. Subsequently, an esophagoscopy was performed. Advancement of the endoscope into the stomach. Inconspicuous conditions there. Insertion of a PEG tube using the thread pull-through method in the typical manner. Inconspicuous conditions. Subsequently, repositioning of the patient for the planned radical neck dissection on the left side. Application of local anesthesia on the left side. Skin spray disinfection. Skin ablation and sterile draping. Creation of a curved skin incision. Separation of the subcutaneous tissue. Removal in the tumor preparation of a spindle-shaped skin area. Removal in the preparation of muscle fibers of the sternocleidomastoid muscle. This showed that the entire neck of region I and region V is affected by tumorous masses. It was then possible to dissect the internal and external carotid arteries anterior and medial to the mass and to dissect the vagus nerve and the hypoglossal nerve with great difficulty. The capsule of the submandibular gland is included in the preparation. Fibers from the digaster muscle are included in the preparation. The accessory nerve cannot be dissected from tumor masses and is unfortunately also removed. Fibers from the scalenus anterior muscle are also removed in the preparation. Exposure of the jugular vein in its most cranial area. Undermining of the same. Ligation of the internal jugular vein cranial and caudal to the tumorous masses. Successive evacuation of Regio I b to Regio V from cranial to caudal. This results in a radical neck dissection on the left side with resection of the internal jugular vein, sternocleidomastoid muscle and accessorius nerve. Dry conditions. Several bypasses are made in region V b to avoid a postoperative hilar fistula. Placement of a 10 Redon drain. Two-layer wound closure. Application of a pressure bandage. Completion of the procedure without complications. Please present the patient to our tumor conference as soon as possible after receiving the final histology to initiate the necessary adjuvant radiochemotherapy.