Positioning of the patient by the surgeon. Entering with the size C small bore tube and examination of the findings. In the area of the oropharynx on the left side, an exophytic mass can be seen at the lower tonsil pole, which corresponds to the already histologically confirmed carcinoma, approx. 2 cm in size with the main mass in the lower tonsil pole, with involvement of the glossotonsillar groove and adjacent tongue base. The mass can be displaced in relation to the pharyngeal muscles. No indication of a deeper infiltration of the tissue. Therefore, primary indication for enoral resection, most likely without flap. Insertion of the McIvor oral spatula. Positioning of the tumor. Resection is performed with the electric needle at a macroscopic distance of at least 1.5 cm from the tumor. The anterior palatal arch, the entire tonsil on the left side, a small part of the base of the tongue and the glossotonsillar groove on the left are resected. The posterior floor of the mouth is affected. However, there is no extensive defect. Adhesions of the tongue to the floor of the mouth are not to be expected due to the very small extent of the resection in this area. Punctual hemostasis. The tumor is stretched on cork and sent in for frozen section diagnosis. No edge-forming formations in the frozen section on the specimen. An R0 resection can be assumed. Hemostasis of the findings enorally and attempt to place a PEG. Entering with the gastroesophagoscope and advancing into the stomach. A spontaneous diaphanoscopy is seen. Despite an extensive layer of fat on the patient's abdomen, indication to attempt PEG insertion using the thread pull-through method. In this case, the trocar, which is inserted up to the point of insertion, is unable to pass through the stomach wall. After three attempts, PEG insertion is discontinued and a nasogastric tube is indicated. In the course of PEG insertion by the <CLINICIAN_NAME> or surgery plan. As there was no penetrating defect, the musculature was whole and aspiration was not to be expected, a tracheotomy was not performed and flap reconstruction was also not performed. Indication for neck dissection on both sides. Injection of 10 ml Ultracaine with added Suprarenin per side in the area of the planned skin incision. Sterile draping and abjoration. Positioning of the patient. Start with the left side: The skin incision is made along a curved line on the anterior edge of the sternocleidomastoid muscle, two QF below the lower jaw, using a 15 mm scalpel. Sharp cutting of the skin, subcutaneous tissue and platysma. The auricularis magnus nerve is exposed and spared. The external jugular vein is cut and ligated. Expose the anterior border of the sternocleidomastoid muscle. Lifting of the subplatysmal flap. Exposure of the submandibular gland, posterior venter of the digaster, accessorius nerve and omohyoid muscle with cervical vascular sheath. A relatively extensive metastasis measuring approx. 4 cm is seen on the accessorius, which is dissected off. There are several metastases below the accessorius, some of which have grown together with the digaster. Demonstration to <CLINICIAN_NAME>, who is responsible for further dissection. The metastases are finally removed together with the posterior belly of the digastric muscle and levels I b, II, III, IV and V are resected. The accessorius nerve was heavily manipulated. Although it is macroscopically intact in its entirety, a loss of function of the nerve is to be expected, at least temporarily. Other branches of the cervical plexus are free. When the specimen was set down caudally in level V b, there was no leakage of chyle. Bipolar coagulation. To minimize the risk of secondary bleeding, the lingual artery on the left side is ligated by <CLINICIAN_NAME>. Placement of a Redon drainage. Two-layer wound closure, 4-0 Vicryl and 5-0 Ethilon. Repositioning of the patient and turning to the right side: skin incision here in the same way. Sharp incision of the skin, subcutaneous tissue and platysma. Expose the submandibularis after lifting the subplatysmal flap, the anterior edge of the sternocleidomastoid muscle, omohyoid muscle, digastric muscle, posterior abdomen, accessorius nerve. Sonographic and palpatory cN0 neck status. The neck preparation level II to V is resected. There is no injury to the non-lymphatic structures, no chyle leakage. The accessory nerve remains intact. The hypoglossal nerve was exposed and spared as well as the common carotid artery, external/internal carotid artery and internal jugular vein. Punctual hemostasis. Creation of a Redon drainage. Two-layer wound closure using 4-0 Vicryl platysma suture and 5-0 Ethilon skin suture. Control of the enoral findings. No bleeding at all. The procedure was therefore completed. Conclusion: Enormous tumor resection of a cT1-2 oropharyngeal carcinoma on the left side with the main mass in the area of the left tonsil. No flap reconstruction necessary. Due to the low risk of aspiration and post-operative bleeding, a tracheotomy is not performed. A nasogastric tube was placed if the attempt to place a PEG was unsuccessful. PEG placement planned in the course of the adjuvant RCT.