Initial PEG insertion: insertion with the gastroscope. After creating the diaphanoscopy, easy insertion of a 15 mm abdominal wall tube. Typical fixation to the abdominal wall. Subsequent repositioning for laser resection: insertion with the spreading laryngoscope. Exposure of the tumor, which is successful. Using the CO2 laser with a power of 5-7 watts, the tumor is successively cut around the healthy tissue. In the caudal-medial area, a small mucosal change is seen, which is also suspicious and is about 1 cm away from the main tumor. This is included in the resection. The specimen is then removed and thread-marked and sent for frozen section. A medial margin sample is also taken and sent for frozen section. Medial margin specimen with at least moderate dysplasia according to pathology. Therefore resection recommended. Relatively scarce in the main preparation after basal, although there were microscopically good margins here. Post-resection also recommended here. Therefore, another resection is recommended. A further layer is removed laterally from the muscle wall. A passing nerve, probably the superior laryngeal nerve, is spared. Subsequently, another marginal sample is taken from the medial edge of the temporal bone, in which the dysplasia was detected. Both are sent for final diagnosis. Subsequent careful hemostasis. Repositioning for neck dissection: skin disinfection. Injection of a total of 10 ml Ultracaine 1% with adrenaline. Then sterile draping. Incision in a typical curved fashion in front of the sternocleidomastoid muscle. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle and the digastric muscle. Exposure of the internal jugular vein, external jugular vein, internal/external carotid artery, vagus nerve, hypoglossal nerve and accessorius nerve. Successive removal of the level II to IV lymph nodes while exposing and preserving the branches of the cervical plexus. Subsequent careful hemostasis. Wound closure in layers with insertion of a Redon drain. Completion of the procedure without complications. Check the enoral situation again at the end. No bleeding here. Overall small carcinoma at the oro-/hypopharyngeal junction, which was resected again basally due to a narrow margin and medially due to dysplasia. Neck dissection on the right. Postoperative loosening of the PEG in a typical manner on the following day. Antibiotics, which were given, should be continued for one week. After receiving the final histology, further procedure or presentation at the interdisciplinary tumor conference.