Induction of anesthesia and intubation by anesthesia colleagues. Injection, sterile washing and draping. Prior to this, a PEG was inserted using the thread pull-through method and diaphanoscopy was performed without any problems. Start with the skin incision in the usual manner and exposure of the platysma and creation of an apron flap by <CLINICIAN_NAME>. Start with neck dissection on the right side by <CLINICIAN_NAME>. The sternocleidomastoid, digastric and omohyoid muscles, the submandibular gland and the cervical vascular sheath are shown here. Level II and III show large metastases, which are laboriously dissected from the internal jugular vein. There is no infiltration of the internal jugular vein. Change of surgeons and continuation of the operation by <CLINICIAN_NAME>. Exposure of the accessorius nerve and release of the neck preparation IIa to Va while sparing the plexus branches. Release of level VI. Turning to the opposite side. Here also visualization of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digastric muscle. There are also several metastases here, also adherent to the internal jugular vein, but not infiltrating. These must also be carefully separated from the internal jugular vein. Release level VI and start free preparation of the larynx. First detach the cervical vascular sheath from the pharynx and larynx area. Detachment of the thyroid gland on the right side, then also on the left side. Release and removal of the hyoid bone with detachment of the infrahyal musculature. Skeletonization of the larynx, initially on the right side. Beginning with the release of the piriform sinus. This is only very partially possible here due to the tumor infiltration. Turning to the other side. Here the piriform sinus can be completely released from the thyroid cartilage. Entering the left paramedian pharynx. Disluxation of the epiglottis. A spatula must be inserted into the mouth for this. Incision of the mucosa along the edge of the epiglottis on the right side and inspection of the pharynx and the tumor region. It can be clearly seen that the tumor has infiltrated the aryepiglottic fold, the ary and the medial part of the piriform sinus on the right side. Therefore, a little more mucosa must be resected on the left side. Care is taken to ensure that a safety margin of 1 cm is maintained. Detachment of the mucosa from the postcricoid region and removal of the larynx below the cricoid cartilage by <CLINICIAN_NAME>. Take marginal samples from all mucosal margins and send for frozen section. In the meantime, a Provox-VEGA is inserted by <CLINICIAN_NAME> in the usual manner. Then the attachments of the sternocleidomastoid muscle are reduced and a myotomy is performed on the esophageal sphincter on the left side. The esophagus is well and easily passable. Start with the pharyngeal suture from caudal to cranial and also from cranial to caudal under the incision of a "T". The frozen section findings are made in the meantime. Carcinoma infiltrates can still be found at the esophageal entrance on the right side, as well as at the base of the tongue on the right side. However, there is normal mucosa between the esophageal opening and the base of the tongue. The pharyngeal suture is reopened and resected both at the esophageal opening and at the base of the tongue. A lot of resection is carried out at the base of the tongue and marginal samples are taken again at the affected areas, which no longer show any invasive carcinoma or carcinoma in situ. The pharyngeal suture is therefore repeated in three layers in the usual manner. At the end, insertion of Redon drains and two-layer wound closure. Insertion of a 10-gauge tracheostomy tube and transfer of the patient to the intensive care unit. Please continue antibiotics for three postoperative days. X-ray pre-swallow on the 10th postoperative day.