First pharyngoscopy: The exophytic tumor is seen, which is located in the area of the hypopharyngeal entrance at the aryepiglottic fold on the right and extends over the anterior wall to the border to the lateral wall, Vallecula is barely reached macroscopically. Initial PEG insertion: insertion of the esophagoscope into the stomach. Once the diaphanoscopy has been performed, a 15 mm stomach wall tube is inserted without complications. Fixation to the abdominal wall in the typical manner. Subsequent transoral laser resection: entering with the spreading laryngoscope. Positioning of the tumor, which is cut around on all sides with a safety margin of at least 1 cm using a 5-pulse CO2 laser. Tumor is resected in toto and is thread-marked for frozen section histology: In the frozen section just towards the base, but in healthy tissue. Carcinoma infiltrates in the cranial area or cranially in the arytenoid fold area. These are subepithelial. Therefore, the cranial area including the vallecula of the lateral epiglottis is resected again. ............................................ here from the cranially adjacent tongue base area to the vallecula. The cranial arytenoid fold was also resected during the resection. Here is another marginal sample supraglottic on the left. The caudal arytenoid fold region is also included again and a frozen section margin sample is taken, which is taken over the arytenoid cartilage. Old marginal samples now in healthy tissue. Therefore, repositioning for neck dissection. First neck dissection on the left: After injecting a total of 10 ml Ultracaine 1 % with adrenaline into both sides of the neck, incision on the left in the typical manner. Exposure of the sternocleidomastoid muscle. Exposure of the digastric muscle. This must be laboriously dissected from a lymph node conglomerate and is partially resected in the process. Exposure of the omohyoid muscle. Visceral development of the lymph node conglomerate in level II. This can be dissected off in toto. The inferior parotid pole can also be removed. Subsequent clearing of level II-V as a whole. Exposure of the internal carotid artery, external carotid artery, superior thyroid artery, internal jugular vein, facial vein. Visualization of vagus nerve, hypoglossal nerve and accessorius nerve. All structures are visualized and preserved. Clearing of the level, also exposing the branches of the cervical plexus. Neck dissection on the right: skin incision in the same way. Evacuation of level II-V in the same way as on the opposite side, but here no suspicious lymph nodes. Exposure and preservation of the structures as on the opposite side. Subsequent careful irrigation of both sides of the neck. Wound closure in layers with insertion of a Redon drain into each side of the neck. Then tracheostoma creation: Small Kocher collar incision, exposure of the thyroid isthmus after splitting the infrahyoid muscles. This is clamped off, severed and supplied by means of puncture ligatures. Presentation of the trachea. Creation of a Björk flap in the 2nd/3rd intercartilaginous space. Epithelialization in a typical manner. Insertion of a laryngectomy tube. At the end of the operation, exchange into size 8 tracheostomy tube. Patient goes to intensive care unit for monitoring after completion of the operation without complications. Continue antibiotic treatment, which was started intraoperatively, for a further 2 days. Nutrition via PEG for approx. 1 week, then carefully build up diet. If necessary, optimize swallowing function by means of swallowing stabilization in the case of extensive mucosal resection in the area of the arytenoid fold with exposed arytenoid cartilage. Wait for the final histology and discuss the findings in the interdisciplinary tumor conference.