First, pharyngoscopy and laryngoscopy again: The exophytic tumor can be seen, which extends below the palatal arch, starting on the left, over the entire tonsillar lobe to the beginning of the tip of the piriform sinus. Sinus tip and esophageal entrance free. Tumor extends to the arytenoid fold, but does not visibly infiltrate it. Resection of the pharyngeal side wall and part of the posterior wall without laryngectomy is now indicated. Defect coverage using an antero-lateral thigh flap. Due to the possibility of infiltration of the carotid artery in the area of the left bulb, coverage of the left leg and, if necessary, a ................ graft for interposition of the common carotid artery. This is followed by radical neck dissection on the left: Creation of an apron flap subplatysmal in a typical manner. Dissection up to the level of the submandibular gland. Careful attention is paid to preserving the external jugular vein. Then first expose the sternocleidomastoid muscle. This is visibly infiltrated by the lymph node conglomerates. The muscle is therefore removed cranially and caudally. The internal jugular vein is dissected caudally and cranially, is also infiltrated by the tumor and is deposited cranially and caudally and ligated or stitched twice. The mass can be dissected from the hypoglossal nerve, as well as from the internal and external carotid artery, including all branches that branch off from the external carotid artery. The vagus nerve is clearly infiltrated by the tumor and cannot be preserved; it is resected in the area of tumor infiltration. Removal of the lymph node conglomerate. The dorsal neck preparation is then removed, preserving the branches of the cervical plexus as far as possible. Then complete the anterior neck dissection. Then modified radical neck dissection on the opposite side in a typical manner. Clearing out level II to V on both sides. Subsequent transcervical tumor resection via pharyngotomy: Suprahyoid muscles are detached from the hyoid bone from the left across the midline to the right. Dissection up to the pharyngeal wall. Entry paramedian left. Exposure of the tumor, which lies approx. 1 to 1.5 cm laterally. The tumor is resected along the arytenoid fold or along the base of the tongue to above the tonsillar lobe and over the hypopharyngeal lateral and posterior wall exclusively over the piriform sinus with a safety margin of 1.5 to 2 cm on all sides. Two thirds of the thyroid cartilage is resected on the left side. The entire specimen is thread-marked on the sides and basally. A marginal sample is taken from the cranial pharyngeal side wall, tonsil lobe and base of the tongue and sent in thread-marked. Also a marginal sample from the epiglottis area, arytenoid fold, extending to the piriform sinus. Carcinoma in situ in both marginal samples. Therefore, another extensive resection of the tonsil lobe cranial side wall to the base of the tongue and epiglottis, everywhere ............... to the piriform sinus. Then another marginal sample from the tonsil lobe and cranial pharyngeal side wall, base of the tongue and epiglottis, reaching everywhere up to the piriform sinus .............. Now no carcinoma in any of the marginal samples. R0 resection now achieved. There is a defect extending from the palatal arch cranially to caudally into the piriform sinus and esophagus. It extends from the medial portion of the hypopharyngeal and oropharyngeal side wall to the base of the tongue and vallecula or arytenoid fold area. The size of the flap is measured. Length of the flap 13 cm, maximum width 8 cm. Careful hemostasis and irrigation of the entire wound area with hydrogen and Ringer's solution is now performed. The antero-lateral thigh flap is then elevated. First mark the 3 perforating vessels. Then mark the flap according to the measurements and the imaginary projection in the suture. Then first cut around the flap medially over the subcutaneous tissue up to the fascia. Exposure of the rectus femoris muscle and dissection up to the intermuscular septum. Exposure of the .............., which largely runs outside the relatively weakly attached lateral vastus. Extend the incision cranially. Exposure of the pedicle, which is strong and easy to dissect. Then cut laterally around the flap from the skin over the subcutaneous tissue to the subfascial fascia. First locate the caudal end of the flap with the pedicle. The pedicle is clamped off, cut and ligated. Then, taking parts of the vastus lateralis muscle with it, successively dissect the flap at the level of the pedicle up to the cranial side. Individual outgoing intramuscular branches are treated with clips. Subsequently, further exposure of the pedicle. Further muscle fibers attached to the pedicle must be severed. The descending ramus of the profunda brachii artery is dissected with accompanying veins up to the entrance to the profunda brachii artery. Outgoing small branches are each supplied with clips. The arteries or the common vein are then clamped and removed. Vessels are treated proximally with puncture ligatures. After careful hemostasis and wound irrigation, the wound in the thigh area is closed in layers, with minimal tension, and a Redon drain is inserted. The femoral flap is then inserted into the defect and sutured into the defect transcervically and transorally using single Vicryl 3/0 button sutures, so that the defect is finally closed completely without tension. The superior thyroid artery and the artery in the pedicle area are prepared for the arterial suture. This is performed using the end-to-end technique with 8/0 Ethilon sutures. After opening the clamp, good arterial flow, good venous return. Subsequent preparation of the external jugular vein and the pedicle vein for the venous suture. The external jugular vein must be dissected relatively far to the periphery until a good flow is visible. Then, after measuring with the vein coupla device, the vein anastomosis is performed with the 3/0 coupla. Good flow can also be seen here. Careful hemostasis is then performed again in the wound area. The tracheostoma previously inserted in the 2nd/3rd inter-cartilaginous space of the trachea in the typical manner is now epithelized. The cervical wound is closed in layers with the insertion of a Redon drain on the right. As one dressing is still missing when the compresses are counted, an X-ray of the neck is taken. This shows a radiopaque structure on the right. Part of the wound is therefore reopened on the right. The dressing can be removed below the sternocleidomastoid muscle and the wound closed. The procedure is now completed without complications. The patient is transferred to the intensive care unit for postoperative monitoring. Please continue antibiotics with Unacid 3 g, 3 x per day, for 3 days. Nutrition via the inserted PEG for 10 days. Please leave the gastric tube in place for splinting. If necessary, build up diet after swallowing porridge. Please carry out flap control via the points marked on the left according to the diagram. Stitches should be removed from the leg after 10 to 12 days at the earliest. Please also arrange physiotherapy here. Postoperative radio-chemotherapy is certainly indicated for cT3/4 cN2c status. Subsequently, elevation of the antero-lateral femoral flap. First marking of the total of 3