First PEG insertion: Insertion of a PEG tube using the thread pull-through method in the typical manner by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Subsequent laser resection: First insert the small bore tube again and assess the findings. The carcinomulcus can be seen in the area of the left vallecula with transition to the lingual epiglottis up to the cartilage and slightly towards the arytenoid fold. Subsequent insertion of the spreading laryngoscope. Tumor is successively resected. Due to the involvement of the epiglottis up to the cartilage, an approx. 2/3 resection of the epiglottis on the left is performed, the subsequent vallecula is removed with hanging pre-epiglottic fatty tissue. Resection towards the base of the tongue far into the healthy tissue, resection at the transition from the pharyngeal wall to the base of the tongue far into the healthy tissue as well as resection of the upper parts of the aryepiglottic fold. The specimen is then thread-marked. Another marginal sample is taken at the border to the vallecula on the right side of the epiglottis extending to the base of the tongue. Both specimens are sent for frozen section. In the frozen section, the edges of the specimen and the marginal specimen are tumor-free. Thus R0 resection here. Thorough hemostasis is performed. Subsequent repositioning for neck dissection and tracheotomy: start with the tracheotomy. Creation of an epithelialized tracheostoma by <CLINICIAN_NAME> and <CLINICIAN_NAME> and reintubation of the patient by the anaesthesia colleagues. Now proceed to radical neck dissection on the left side. First, a skin incision is made along the anterior border of the sternocleidomastoid muscle on the left side. Dissection from the cranial to the caudal side, directly encountering multiple large, coarse metastases in region II b to region V on the left side. Cranial exposure of the posterior venter of the digaster muscle. Exposure of the accessorius nerve, which can be preserved. Cranial exposure of the internal jugular vein. Exposure of the hypoglossal nerve, which could also be spared. Exposure of the internal and external carotid artery. Showing the caudal part of the omohyoid muscle, which unfortunately has to be removed. Showing the caudal aspect of the internal jugular vein. The entire lymph node package is dissected out in toto from cranial to caudal, taking the sternocleidomastoid muscle and the internal jugular vein with it, and removed without difficulty. Removal of the internal jugular vein caudally in region V. Creation of a bypass ligature there. Creation of several bypass ligatures to avoid a postoperative chyle fistula on the left side. During the dissection, it was found that the external carotid artery was also affected by the tumor and also had to be treated by means of a bypass and removed. Dry conditions there. Multiple wound irrigation with hydrogen peroxide and Ringer's solution. Dry conditions. No evidence of a chyle fistula on the left. Placement of a 10 Redon drain. Subcutaneous suture. Skin suture. Application of a pressure bandage. Now repositioning of the patient to perform a neck dissection on the right side. Skin incision along the anterior border of the sternocleidomastoid muscle. Expose the digastric muscle cranially, the accessorius nerve and the omohyoid muscle caudally. Exposure of the cervical vascular sheath. Dissection along the cervical vascular sheath from caudal to cranial. Successive removal of the posterior neck preparation while sparing the accessorius nerve, the cervical plexus and the cervical accessorius ramus. Successive removal of the anterior neck preparation. Dry conditions. Wound irrigation using hydrogen peroxide and Ringer's solution. Two-layer wound closure. Application of a pressure dressing and completion of the procedure without complications. Finally, re-insertion of the small irrigation tube and assessment of the resection area. No more bleeding here. During resection, several vessels were treated with clips; these areas are also inconspicuous, with no evidence of bleeding. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. Please provide nutrition via the inserted PEG tube for approx. 1 week, then if necessary, dietary support. Dysphagia is to be expected, therefore swallowing rehabilitation should most likely also be necessary. Presentation in the interdisciplinary tumor conference for radiochemotherapy after receiving the histology.