Pharyngoscopy is now performed. Palpation of the tonsil tumor, which is mobile. Based on the palpation findings and the CT findings, the decision is made to attempt a transoral resection. PEG placement: insertion of the flexible esophagoscope and advancement into the stomach. There, after creating a spontaneous diaphanoscopy, insertion of a 15 mm stomach wall tube without any problems or complications. Fixation to the abdominal wall in the typical manner. Now insertion of the McIvor spatula. The tumor is macroscopically incised on all sides at a distance of 1 to 1.5 cm, including deep resection of parts of the pharyngeal wall. Fat is partially visible, but relatively far cranially and towards the lower jaw. The posterior palatal arch can be completely preserved, the anterior palatal arch falls away, parts of the base of the tongue fall away, resection reaches just to the beginning of the hypopharynx. The specimen is removed in toto and marked with a suture. Caudally, a marginal sample of tongue base mucosa, tongue base soft tissue and soft tissue of the pharyngeal wall is taken, as the borders to the tumor appear somewhat narrow here. In the frozen section, the tumor also extends just to the caudal margins. In conjunction with the marginal specimen, however, this is an R0 situation. Therefore, no flap coverage is necessary if the wall is still intact. Transfer to neck dissection on both sides: First inject a total of 10 ml Ultracaine 1% with adrenaline into the sides of the neck on both sides. Start with neck dissection on the left: curved, submandibular skin incision. Exposure of sternocleidomastoid muscle anterior border, exposure of omohyoid muscle, digastric muscle. Exposure of the cervical vascular sheath, internal jugular vein, internal/external carotid artery, vagus nerve, accessorius nerve and hypoglossal nerve. Successive development of the dorsal neck preparation. The larger, cystic lymph node metastasis is removed in a block with the other lymph nodes. Levels V b and V a are also removed while preserving the branches of the cervical plexus. The lymph nodes are then removed from the anterior neck preparation or revision level I b. This also includes exposure of the submandibular gland and removal of the capsule. The facial vein is exposed and preserved, as are the superior thyroid artery and vein. This ultimately results in removal of level I b to V. This is followed by careful hemostasis. Irrigation with H2O2 and Ringer's solution. Wound closure in layers with insertion of a Redon drain. Then neck dissection on the right side: here, as on the opposite side, the levels II to IV are evacuated in a typical manner with exposure of the corresponding structures, as on the opposite side. Finally, careful irrigation with H2O2 and Ringer's solution and hemostasis. Wound closure in layers and insertion of a Redon drainage. Due to the relatively extensive defect and the involvement of the base of the tongue, the decision was made to perform a temporary protective tracheotomy. A small Kocher collar incision was made. Subsequent dissection through subcutaneous tissue to the infrahyoid musculature. Spreading of these. Exposure of the thyroid isthmus. This is passed underneath, clamped off, severed and supplied by means of puncture ligatures. Subsequent exposure of the trachea. Between the 2nd and 3rd cartilage a small, broadly pedunculated Björk flap. This is epithelized in a typical manner. Finally, insertion of an 8 mm tracheal cannula. The procedure was completed without complications. Thoracic inspection revealed no signs of bleeding at the end of the operation. Patient admitted to the intensive care unit for 1 night for monitoring. Feeding via the inserted PEG tube for 1 week, followed by gradual diet build-up. Presentation at the interdisciplinary tumor conference to discuss adjuvant therapy.