Transferring the patient to the operating theater. Carrying out the team time-out with the anesthesia colleagues and induction of intubation anesthesia by the colleagues. Induction of anesthesia through the existing tracheostoma. Now attempt panendoscopy. The patient is extremely difficult to view with the small bore tube due to the severe postradiogenic changes. No abnormalities in the hypopharynx and supraglottic larynx as far as can be assessed. The glottis cannot be adequately assessed, nor can the esophageal opening. A flexible gastroesophagoscopy is not performed as the mucosa is very vulnerable to contact and the lumen is very narrow. Closer inspection with the small flexible scope reveals an almost obliterated esophageal lumen. The placement of a nasogastric tube is also frustrating after several attempts. The tumor is now resected at the edge of the tongue on the left side with a safety margin of approx. 1 cm. Removal of the specimen under constant blood control using bipolar coagulation forceps and palpatory control. Now mark the suture and send the specimen for frozen section examination. After receipt of the frozen section findings, it is found that there is still carcinoma forming the margin in the specimen in the area of the posterior and medial margin (up to the central specimen). The decision is now made to perform a resection. The resection is performed from posterior to mid-medial and the specimen is again sent in thread-marked for histological frozen section examination. The 2nd frozen section is now reliably tumor-free. In summary, an R0 resection can therefore be assumed. Subtle hemostasis using bipolar coagulation forceps and completion of the procedure without complications. Finally, inspection of the fistula at the upper lateral edge of the tracheostoma on the left side. This shows a fistula channel approx. 2-3 mm wide, which is sharpened with the curette after obtaining a sample biopsy and a granulation-promoting dressing material is inserted. Please await the final histopathological assessment and case presentation in our tumor conference.