Transfer of the patient to the operating theater. Introductory consultation with the anesthesia colleagues. Induction of intubation anesthesia by the colleagues. Start of surgery using oesophagogastroscopy with the flexible instrument. After performing a positive diaphanoscopy, the PEG tube is placed in the usual way using the thread pull-through method. No complications here. Panendoscopy to determine the extent of the tumor. The tumor is mainly located in the left piriform sinus and spreads to parts of the lateral pharyngeal wall. The posterior pharyngeal wall and postcricoid region are free. The patient is now repositioned in the head reclination position and the surgical field is covered and wiped. Start the operation by means of an apron flap incision extending caudally to just below the cricoid. Care is taken to make the incision approx. 2 QF below the mandible so as not to jeopardize the marginal ramus. After cutting through the cutis and subcutis as well as the platysma, the subplatysmal preparation of the apron flap is carried out in the usual way from caudal to cranial. After exposing the submandibular gland on both sides, the apron flap is sutured. Now expose the anterior edge of the muscle on the left side and perform the left neck dissection by <CLINICIAN_NAME>. To do this, expose the sternocleidomastoid muscle in depth. Exposure of the omohyoid muscle and dissection up to the cranial hyoid bone. Knockdown of the omohyoid muscle. Identification and free dissection of the accessorius nerve. Identification of the digastric muscle. Now also identification of the cervical vascular sheath and freeing of the cervical vascular sheath from the neck preparation. Regions II, III, IV and V are removed en bloc from cranial to caudal while sparing the nervous and vascular structures. Subtle hemostasis using bipolar coagulation forceps. During dissection, the hypoglossal nerve is exposed and followed medially. The superior thyroid artery and the superior laryngeal nerve are also exposed. Laryngeal exposure after placement of vascular clips and bipolar coagulation. Now also preoperative release of the cervical vascular nerve sheath from the pharyngeal musculature. Perform isthmus splitting on the thyroid gland and separation of the thyroid gland from the laryngeal skeleton on both sides. Now enter the 3rd intertracheal space and transfer intubation to an 8 mm LE tube. Neck dissection on the right side by <CLINICIAN_NAME>. Same procedure as on the left side. The superior thyroid artery is dissected free and also clipped at its division in order to obtain a possible connecting vessel with a free flap. Dissection of the thyroid gland and free dissection of the common carotid artery. Release of the major and minor cornu of the hyoid bone. Now release the right piriform sinus, for this purpose the upper edge of the cartilage with the upper horn is incised and slit with a new 15 mm knife and the piriform sinus is bluntly released using a freer. On the left side, only the upper horn is released to avoid entering the tumor, which is mainly located in the piriform sinus. Now perform the tracheotomy in the 3rd interspace and suture the lower sutures in a characteristic manner. Now enter suprahyoidally and locate the epiglottis. Pull up the epiglottis and dissect the pharyngeal mucosa in order to protect it as much as possible. The pharyngeal mucosa is now incised on the right side close to the epiglottis and dissected up to the aryepiglottic fold or arytenoid cartilage. Great care is taken here to ensure that as much mucosa as possible is spared. The subcutaneous fatty tissue is also removed while preserving the piriform sinus. Now dissection along the epiglottis on the left side. The tumor is clearly visible as an ulcer in the lateral pharyngeal wall as well as the medial wall of the piriform sinus and the aryepiglottic fold; there is also a small exophytic extension to the lateral posterior, where the tumor is bypassed at a distance of 1 cm. The remaining mucosa is spared. Connect the two mucosal incisions at the level of the cricoid. Now enter the trachea or detach the trachea directly below the cricoid. Creation of a chimney and placement of the trachea under the cricoid after preparation of a caudally pedicled mucosal flap from the cricoid cartilage plate for the chimney using a scalpel and Freer. A total of 3 cartilage clips are obtained above the tracheostoma, the lowest cartilage clip of which is incised and divided in the middle to ensure a particularly wide tracheostoma. Now release the cricoid from below close to the larynx and connect the two preparation parts. Removal of the larynx on closer inspection of the larynx, the tumor looks widely resected in situ with a safety margin of 1 cm in each direction. Now 7 marginal samples are taken, these are free of tumor in the frozen section afterwards (R0). Perform a myotomy of the inferior hypopharyngeal muscle and insert an 8-gauge Provox. Now close the wound using inverted sutures in the usual technique and in a T-shape. As a second layer, the muscles of the constrictor pharyngis muscle are sutured over the first suture. The esophagus should be sufficiently wide. Careful and gradual hemostasis on both sides and irrigation of the site. Insertion of two 10-gauge Redon drains, two-layer wound closure and suturing of the tracheostoma in the usual manner. Re-intubation with a 10-gauge Rüsch cannula and completion of the operation after a final consultation with the anesthetist.