After induction of anesthesia and bronchoscopic intubation by the anesthesia colleagues and preparation of the patient, the first step is positioning. A pharyngo/laryngoscopy is performed. The carcinoma can be seen in the area of the right piriform sinus, which is completely filled in, with fixation of the laryngeal skeleton via the medial wall of the piriform sinus. Endolaryngeal free conditions with clear infiltration of the right hemilarynx on computed tomography and palpation. Confirmation of the indication for laryngectomy. Clinically, there is a monstrous mass on the right with an area of non-displaceable skin measuring approx. 4 x 5 cm. In the area of the remaining mucous membranes, the esophageal entrance is free, as is the posterior wall of the hypopharynx and the entire left side. The patient is now repositioned. Injection of xylocaine with the addition of adrenaline. Form an apron flap by cutting around the palpatorily infiltrated skin. Widening of the incision on the right side around the lobule with infiltration of the caudal parotid pole. On the left side, regular elevation of the apron flap with dissection of the platysma. In the area of the metastasis, careful dissection of the otherwise healthy skin in the surrounding area. In some cases, however, significant inflammatory changes to the skin with redness and vulnerability. Skin incision around the lobule. Dissection of the lobule, exposure of the anterior wall of the auditory canal and exposure of the mastoid. After raising the apron flap, start with the left-sided neck dissection to secure the healthy vessels. Exposure of the sternocleidomastoid muscle, exposure of the omohyoid muscle. Exposure of the submandibular gland, including the caudal capsule. Exposure of the digastric muscle, removal of the anterior neck preparation with careful protection of the facial vein, the superior thyroid artery, the cervical artery and the hypoglossal nerve. Free preparation of the internal jugular vein. Exposure of the accessorius nerve. Dissection of the accessorius triangle with careful protection and dissection of level Va with careful protection of the cervical plexus branches. Finally, with dry wound conditions, exposure of the left side of the hyoid and release of the hyoid, exposure and skeletonization of the larynx, release of the left-sided laryngeal horn with release of the left-sided piriform sinus. Dissection of the left lobe of the thyroid gland, exposure of the cricoid cartilage and trachea. Now turn to the opposite side. Successive development of the monstrous mass. Caudal exposure of the internal jugular vein, common carotid artery and vagus nerve. Subsequent resection of the mass, which extensively infiltrates the scalenus and paravertebral musculature. Complete infiltration of the cervical plexus roots. The accessory nerve is not visible, the mass can be lifted off the mastoid with the periosteum. Cranially, the tumor clearly infiltrates the caudal part of the parotid gland. Longitudinal approach to the mandible, the submandibular gland is free, but a further metastatic conglomerate can be seen in level Ib after visualization of the pointer. Identification of the facial nerve trunk, which is otherwise left in the remaining glandular part with its subdivision. Clear infiltration of the oral branch, which is resected. Exposure of the mandible, but no infiltration here. The periosteum is also not infiltrated in the area of the mandible. Resection of the conglomerate of Ib with resection of the submandibular gland. Protection of the lingual nerve, which is not infiltrated. Exposure of the intact carotid bulb. Now clear infiltration of the vagus nerve and the hypoglossal nerve. Resection of both nerves as well. Subtotal resection of the external carotid artery branches, the internal carotid artery can be detached from the tumor. Certainly no infiltration here. Finally, after resection of the metastases, some of which extend far into the paravertebral region with surrounding muscle, removal of the conglomerate in toto. This can be accomplished by leaving a small tissue bridge to the primary. No open tumor here. The tumor is now exposed on the right side of the larynx, the thyroid lobe is detached, the piriform sinus is left completely intact on the larynx, the tumor is inserted enorally at the level of the epiglottis, successive development with sparing expansion on the left side in the area of the aryepiglottic fold. Now a good overview of the tumor, which is confirmed as described above. Removal of the tumor with a safety margin of 1.5 cm in the area of the pharyngeal side wall. Postcricoid no growth, also no extension towards the esophageal entrance as described above. Resection of the tumor macroscopically completely in sano, including the laryngeal skeleton, no infiltration of the cricoid cartilage or trachea. At the mucosal level, covering of the tumor with marginal samples, in addition, after close inspection of the pharyngeal tube, small punctiform lesions can now be seen, remote from the tumor in the area of the posterior pharyngeal wall and on the left side. Slightly indurated on palpation and macroscopically unclear. Excisional biopsy of one of the lesions in case of possible differential diagnosis of satellite metastasis. In the frozen section diagnostics, all tumor-covering edge samples show carcinoma and dysplasia free, so that an R0 situation is present here. The tumor.................... lesions are lymphoepithelial hyperplasia with at most low-grade dysplasia after complete embedding, so that satellite metastasis can be ruled out here. After completion of the tumor resection, the caudal pharyngeal tube area now shows a sufficiently wide and regular esophageal entrance. Cranially in the area of the pharyngeal side wall at the transition to the base of the tongue, the conditions are somewhat narrow. In conjunction with the completely radical resection of the right-sided soft tissues of the neck with the only remaining common carotid artery, the indication for elevation of a myocutaneous pectoralis major flap with a large muscle portion for soft tissue coverage of the pharyngeal tube and the soft tissues of the neck was established. A left lateral myotomy is performed in the area of the upper esophageal sphincter, an 8.0 mm ............. is placed in the cranial tracheal insertion area; this is successful and without any problems, the anterior wall of the trachea is shortened to position the provost prosthesis at a height, and then the left sternal insertion of the sternocleidomastoid muscle is removed. Marking paramillary of the pectoralis major flap, elevation of a 6.5 x 4.5 cm spindle for insertion in the base of the tongue. Extensive dissection of the pectoralis major muscle and subtotal resection of the muscle. Development of a large-area muscle flap, complete isolation on the vascular pedicle after reliable identification of the vascular bundle. After complete release of the flap, cranial tunneling, insertion of the excellent vital skin island into the pharyngeal defect with closure of the defect, this is achieved without tension and sufficiently. Adaptation of the muscle to the left-sided infrahyoid musculature as well as to the right-sided paravertebral muscle stumps, but good soft tissue coverage of the entire pharyngeal tube, which is now completely covered, as well as coverage of the carotid artery and good soft tissue padding. Careful hemostasis in the chest area. Insertion of two 10-gauge Redon drains and careful, strong wound closure. Then fold back the apron flap, successive suturing of the tracheostoma and careful two-layer wound closure with adaptation of the resected right-sided skin with as little tension as possible. Finally, reintubation to a size 10 low cuff cannula, which is suture-fixed, and completion of the procedure without any indication of complications. Conclusion: Intraoperative R0 resected cT4a cN3 right hypopharyngeal carcinoma with multilocular and ..................... deep right cervical metastasis with partial radical parotidectomy and resection of the hypoglossal nerve and vagus nerve. Due to the extent of the tumor, an escalation of adjuvant therapy should be discussed. Please carry out an X-ray pelvis on the 10th postoperative day.