Induction of anesthesia and intubation by the anesthesia colleagues. The tracheotomy is then performed by <CLINICIAN_NAME> and the PJ. For this, skin incision below the cricoid cartilage, then dissection up to the musculature, splitting of the musculature at the linea alba. Exposure of the thyroid isthmus, separation of the thyroid isthmus. Exposure of the anterior wall of the trachea and creation of a visor tracheotomy between the 2nd and 3rd tracheal cartilage. Creation of a mucocutaneous anastomosis and reintubation. Then insertion of the mouth blocker and adjustment of the tumor. Before this, the tumor was inspected again with the Kleinsasser B-tube. The tumor is located in the vallecula with transition to the lingual surface of the epiglottis and the base of the tongue on the left side. The oral retractor is then inserted and tumor resection begins. For this, 1/3 of the epiglottis must also be removed and dissection up to the base of the tongue. Hemostasis using monopolar coagulation. The preparation is thread-marked and sent to the frozen section. A resection is taken before the frozen section, as it can be seen that the median margins are barely resected. This resection is also sent to the frozen section. In the frozen section itself, all margins are tumor-free and also free of carcinoma in situ. No tumor tissue in the frozen section. Then repositioning for neck dissection on the left side. For this, skin incision in the usual manner. Exposure of the anterior margin of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland. Level IIa and b show a large metastasis. Then exposure of the internal jugular vein, the cervical vascular sheath and dissection of the metastasis from the internal jugular vein, including resection of the facial vein, as this infiltrates the tumor. The superior thyroid artery is also resected as the tumor infiltrates it. The accessory nerve, hypoglossus and vagus remain intact. A small medial part of the sternocleidomastoid muscle must also be removed. Then remove the remaining neck level and turn to the opposite side. Similar picture here. Skin incision in the usual manner. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle, submandibular gland, digastric muscle and cervical vascular sheath. Here, too, a large metastasis is seen in level II, which is carefully dissected from the internal jugular vein. Here too, the facial vein cannot be retained, but all other structures can be retained. Clearing of the remaining neck levels and insertion of Redon drains on each side and two-layer wound closure. The patient is transferred to the intensive care unit for monitoring while awake. Before the tumor resection, a PEG was inserted using the thread pull-through method. This is successful with good diaphanoscopy. Please feed via PEG for 3 days, then build up diet and TE diet. Presentation of the patient in the tumor conference after receipt of the histology.