Induction of anesthesia by the anesthetist. Entry with the small bore tube and inspection of the hypopharyngeal and laryngeal areas. This is extremely difficult as the patient is almost impossible to adjust. The epiglottis and the piriform sinus and postcricoid region can be visualized with difficulty. The tumor itself is barely visible and is located on the right in the area of the aryepiglottic fold. Further adjustment is not possible, not even after 3-fold relaxation. Insertion of a nasogastric tube and injection of xylocaine/adrenaline mixture in the neck, then sterile washing and draping. Now form an apron flap in the usual manner. Start on the right side with dissection of the sternocleidomastoid muscle and the cervical vascular sheath. Detach the cervical vascular sheath from the larynx area. Then switch to the opposite side. Here too, detachment of the cervical vascular sheath and the sternocleidomastoid muscle from the larynx. Exposure of the omohyoid muscle on both sides. Exposure of the hyoid bone and detachment of the hyoid bone from the base of the tongue, as the hyoid bone is to be integrated into the laryngeal preparation. Visualization of the thyroid gland on both sides and detachment of the thyroid gland from the trachea and larynx. Detachment of the upper horn of the thyroid cartilage, initially on the left side by severing the constrictor pharyngis muscle. Detachment of the piriform sinus with the freer from the thyroid cartilage. Switch to the right side and also detach the constrictor pharyngis muscle from the thyroid cartilage and the upper horn of the thyroid cartilage. Then release the piriform sinus with the freer. Now enter the mouth with a TE spatula and elevate the base of the tongue. Then enter the pharynx directly above the hyoid bone. Create a small pharyngotomy. Pull out the epiglottis and release the pharyngeal mucosa and laryngeal preparation along the lateral edges of the epiglottis. This is done carefully up to the postcricoid region. The tumor is now completely visible. The tumor encompasses the aryepiglottic fold, the petiolus and then extends into the glottis. A lot of mucosa can be spared postcricoidally and in the area of the piriform sinus. Deposit the laryngeal preparation directly below the cricoid cartilage. Removal of marginal samples in the pharyngeal region. These are all tumor-free. The difficulty now arises that the patient has already had a tracheostomy and this tracheostomy was also very deep, so the entire tracheostoma, including the torn-out sections, must be completely revised. The granulation tissue must be removed and a lot of skin mobilized to create a mucocutaneous anastomosis. Then perform an anterolateral myotomy by <CLINICIAN_NAME> and insert the Provox prosthesis 0.5 cm below the upper edge of the trachea on the posterior wall of the trachea in the usual manner. Pass the pharyngeal suture through <CLINICIAN_NAME>, initially using inverting single button sutures starting from caudal to cranial. So much mucosa is preserved in the area of the base of the tongue that the mucosa can be adapted without forming a "T". Then place a 2nd, now continuous pharyngeal suture over it. Then adaptation of the thyroid gland so that it does not deepen the tracheostoma crater. Before the pharyngeal suture, a myotomy of the sternocleidomastoid muscle was performed on both sides by <CLINICIAN_NAME>. Wound irrigation and hemostasis using bipolar coagulation. Insertion of two 10-gauge Redon drains and two-layer wound closure with completion of the tracheostoma. Finally, the atheroma on the left axilla area is removed. Spindle-shaped incision and dissection in the subcutaneous area, then two-layer wound closure. Multiple intraoperative demonstrations on <CLINICIAN_NAME>. The patient is ventilated in the intensive care unit and can wake up the following day. Please continue the intravenous antibiotics for 3 days, after 10 days an X-ray gruel swallow and if no fistula is found, diet build-up. After receiving the histology, the patient is presented at the tumor conference.