First, induction of anesthesia and intubation by the anesthesia colleagues. Intubation was very difficult and only possible orally with great difficulty, then sterile washing and draping, prior inspection with the small water tube and visualization of the tumor, the tumor is located on the medial wall of the piriform sinus and extends to the aryepiglottic fold and the arytenoid cartilage on the left side. The tumor is exophytic and affects the entire left medial and anterior wall of the piriform sinus; the tip of the piriform sinus and the esophageal entrance are tumor-free. A PEG is now inserted using the suture pull-through method with good diaphanoscopy. Then sterile washing and draping and creation of an apron flap in the usual manner. Then release of the larynx and detachment of the neck vessel sheath on both sides. Release of the piriform sinus on the right side, this is successful without any problems. Then only very slight and partial release of the piriform sinus on the left side, then release of the hyoid bone and performance of the tracheotomy in the usual manner directly below the cricoid cartilage. Then perform the pharyngoscopy. To do this, enter with the Hartmann spatula directly above the epiglottis. Then disluxation of the epiglottis and detachment of the mucosa of the lingual surface of the epiglottis and detachment of the larynx, initially on the right side. Then inspection of the tumor and removal of the tumor in the pharyngeal part in the piriform sinus on the left with a safety margin of 1.5 cm and removal of the larynx below the cricoid cartilage. Removal of marginal samples from the mucosa. All marginal samples are tumor-free, free of carcinoma in situ and without high-grade dysplasia. Now inspection of the mucosa, intraoperative demonstration on <CLINICIAN_NAME> and <CLINICIAN_NAME>. A joint decision is made to dispense with a transplant as there is still sufficient local mucosa. Now complete the neck dissection on both sides, on the right side through <CLINICIAN_NAME> and <CLINICIAN_NAME>. For this, expose the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digastric muscle. Then free preparation of the internal jugular vein and the facial vein, then removal of the neck preparation IIa to Va while sparing the plexus branches. Several small roundish metastases were found in level II, the levels were sent in individually as part of the lymph node study and the neck dissection was carried out on the left side at the same time. This revealed a very large lymph node conglomerate that completely infiltrated the internal jugular vein, which was therefore removed. The vagus nerve was also found to be infiltrated. In consultation with <CLINICIAN_NAME>, this is also resected; the metastasis can then be detached from the common carotid artery and the external and internal carotid arteries. The accessorius nerve can be preserved, but the more distal plexus branches are interspersed with metastases and infiltrated, so most of these must be resected, resulting in a radical neck dissection on the left side and a modified radical neck dissection on the right side. A Provox-Vega prosthesis is then placed in the usual manner, followed by a three-layer pharyngeal suture in the usual manner. Incision of the tracheostoma in the usual manner and two-layer wound closure after insertion of 2 Redon drains.