At the start of the operation, the surgeon positions the patient. After induction of anesthesia, 3 g of Unacid is administered i.v. The oropharynx, hypopharynx and larynx are then inspected again. The tumor is as described above and in comparison with the CT scan, the tumor is limited to the left hypopharynx. The tip of the piriform sinus, the entrance to the esophagus and the entire piriform sinus on the right are tumor-free. The larynx appears infiltrated like a tumor, the thyroid cartilage is perforated. On the left, the tumor attaches to the hyoid bone. After repositioning and alcohol disinfection with infiltration anesthesia, the skin incision is made on the right side along the anterior edge of the sternocleidomastoid. Clearing out the lateral neck preparation after exposing the cervical vascular sheath and the accessorius nerve as well as the deep cervical plexus branches. From cranial to caudal to below the omohyoid muscle and then dissection medially along the digastric muscle onto the capsule of the submandibular gland. Clear the medial neck preparation, also exposing the hypoglossal nerve and protecting it. Locating the superior laryngeal nerve with its accompanying vessels. Ligation of the same. Now identical procedure on the left side. Here, tumor lymph nodes are seen extending to the mastoid and in the supraclavicular fossa far to the lateral and nuchal side, also skin incision along the anterior edge of the sternocleidomastoid. Exposure of the accessor nerve, which is surrounded by tumor masses but can be bluntly released from them. Dissection of the cervical vascular sheath in its course. Exposure of the vagus nerve and the deep cervical plexus branches. Locate the thoracic duct and dissect it laterally. It becomes apparent that the tumor-infiltrated lymph nodes extend far to the side and infiltrate the accessorius at the posterior edge of the sternocleidomastoid. It was therefore decided to remove the accessorius and sternocleidomastoid cranially and to explore the neck block laterally in one piece. Also remove and cut the cervical plexus branches. Dissect down to the first rib caudally and laterally to near the acromioclavicular joint. Dissect nuchally to below the trapezius muscle, clearing out the complete regions 1, 2, 3, 4, 5 and 6. Dissect cranially to the prelaryngeal muscles and to the capsule of the submandibular gland; the hypoglossal nerve can also be exposed and preserved here. Subsequently raise the apron flap and turn towards the larynx. Dissect the infrahyoid muscles from the hyoid bone and knock them down. This shows that, as already suspected, the left paramedian thyroid cartilage has been perforated and the tumor is infiltrating the prelaryngeal musculature. The detached musculature is readapted using Vicryl sutures. The right prelaryngeal musculature is then separated and knocked down. The right piriform sinus is then detached from the thyroid cartilage skeleton. Subsequent right paramedian approach to the epiglottis and opening of the pharynx. Preservation of the linugal epiglottis mucosa and preparation of the aryepiglottic fold to the ary on the right side. Separation of the piriform sinus from the cricoid cartilage, resection of the tumor now under visual control, including parts of the base of the tongue and the lateral pharyngeal wall on the left up to parts of the piriform sinus. The posterior pharyngeal wall remains completely intact, as does the tip of the left piriform sinus. Now carefully stop the bleeding. Removal of the laryngeal preparation, taking the former tracheostoma with it, previously creating a new tracheostoma with placement of the lower tracheostoma sutures. Now removal of the hyoid bone, which appears to have been attached to the tumor on the left. Therefore, removal of the hyoid bone with part of the surrounding musculature while sparing the hypoglossal nerve for final histology as a resection. Representative marginal samples are then taken, which are found to be tumor-free by pathology, so that a safe R0 resection can be assumed. In the further course, consultation of <CLINICIAN_NAME> from the phoniatrics department. Application of a size 8 provox prosthesis in the typical manner. Finally, careful hemostasis. H202 irrigation Insertion of 2 Redon drains. Inverting pharyngeal suture. Subsequent two-layer wound closure in the midline. Finally, renewed irrigation, check for wound dryness and two-layer skin suture and readaptation of the remaining tracheostoma. Intraoperatively, 2 x 3 g of Unacid were administered, antibiotics should be continued for 5 days, the patient was admitted to the intensive care unit awake.