After induction of anesthesia by anesthesia colleagues, together with anesthesia, laryngoscopy and attempt at tracheoscopy. The glottic plane itself is largely displaced with a well adjustable glottic plane, a complete passage with the tracheoscope is initially unsuccessful, but intubation is nevertheless problem-free. After positioning the patient, first turn to flexible esophagogastroscopy. To do this, enter with the gastroscope under laryngoscopic control. Careful pre-scanning under constant air insufflation into the stomach - this is successful without any problems despite pre-therapy. The stomach itself is inconspicuous and clear. On reflection, the esophagus shows postradiogenic changes, in part somewhat vulnerable and especially in the distal part with typical postradiogenic telangiectasia, but without suspicious parts. As far as can be assessed, no evidence of recurrence of the previously known esophageal carcinoma. Now entering with the Kleinsasser tube under dental protection after inspection of the inconspicuous oral vestibule. The oral cavity, including the floor of the mouth, tongue and soft palate, is unremarkable. Also the oropharynx, with a slightly hyperplastic tongue base and folded vallecula, otherwise tumor-free. Inspection of the hypopharynx, which is unremarkable and clear up to the tips of the piriform sinus and the entrance to the esophagus, and the postcricoid region is also clear. On exposure of the glottic plane, an exophytic, largely ulcerated tumor can now be seen, which infiltrates the entire hemilarynx, extends extensively into the anterior commissure and largely displaces the glottic plane. As far as possible due to the tumor masses, adjustment of the subglottic level. Here, too, a subglottic growth of at least 1.5 cm can be seen, especially in the area of the anterior commissure, below which the mucosa appears to be free again, as far as can be assessed. The right pocket fold is edematous and submucosally indurated. Tumor growth is also present here. The right vocal cord level is also largely consumed by tumor. At the transition to both arytenoids, regular mucosa can be seen again, so that the tumor growth remains limited to the endolaryngeal area of the mucosa, however, transition to the subglottis. After demonstrating the findings and discussing the case with <CLINICIAN_NAME>, the decision was made to debulk the tumor due to the extent of the tumor and the clinical condition in order to avoid a premature tracheostomy. Adjustment of the glottic plane with the small bore tube. Securing of the tube with compresses and subsequent tumor debulking with the CO2 laser with retraction of both vocal folds consumed by the tumor. Laser vaporization of the open tumour and laser vaporization of the adjacent mucosal oedema and creation of a wide glottic gap. Confirmation of subglottic expansion. Subsequently, with dry endolaryngeal conditions and wide glottic access, termination of the procedure at this point. Subsequent extubation of the patient without any problems. The samples were sent for urgent definitive histology. Conclusion: Overall, high-grade diagnosis of at least cT3 glottic carcinoma with extension to the subglottis. Postoperatively, please demonstrate the findings of the CT imaging to our colleagues in radiology - as far as can be assessed, there appears to be arrosion of the thyroid cartilage, but no breakthrough. Depending on the assessment by our radiology colleagues, repeat imaging if necessary. After receiving the definitive histology, please present the multimorbid patient to our interdisciplinary tumor conference. The tumor appears to be easily resectable via a laryngectomy - please complete the preliminary findings with evaluation of the radiation field. If the larynx was in the radiation field during the initial treatment, flap coverage is also indicated. Interdisciplinary case discussion, if necessary also with colleagues from internal medicine and anesthesia, alternatively primarily palliative supportive procedure.