After bronchoscopic intubation of the patient, the anesthesiology colleagues first perform a pharyngo-laryngoscopy to determine the extent of the mass again. This revealed the aforementioned mass in the area of the left piriform sinus, the right piriform sinus anterior and lateral wall extending into the tip of the piriform sinus and infiltrating from here towards the arytenoid and the left hemilarynx. Pronounced edema also in the area of the aryepiglottic fold. The left vocal fold is edematous. This confirms the indication for laryngectomy. Due to the circumscribed extension in the area of the hypoharynx and piriform sinus, most likely with primary closure. Now reposition the patient with xylocaine and adrenaline. Skin incision to lift an apron flap. Cut through the skin and subcutaneous tissue. Separation of the platysma. Creation of a platysma flap on both sides and lifting of the apron flap. Suturing of the flap. Exposure of the external jugular veins on both sides, these remain intact on both sides. An anterior branch of the external jugular vein is ligated on the left side. Now first perform the neck dissection. Start with the left side. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland. Resection of the caudal part of the capsule, exposure of the entire length of the digastric muscle. Release of the anterior neck preparation with preservation of the superior thyroid artery and resection of the cervical artery. Exposure and preservation of the hypoglossal nerve. A metastasis measuring approx. 5 x 3 without peronodal or infiltrative growth and adherent to the sternocleidomastoid muscle can now be seen on the cervical vascular sheath in the area of the jugulo-facial angle. Dissection of the internal jugular vein after previous visualization of the accessorius nerve. Operation on the internal jugular vein, which, like the facial vein, is very weakly developed on this side, is coagulated and removed. Complete dissection of the vein. Release of the accessorius triangle, lateral exposure of the internal jugular vein with careful protection of the common carotid artery and vagus nerve. Include the cervical artery here. Now carefully evacuate levels Va and Vb while carefully preserving the plexus branches without evidence of lymphatic leakage. Careful inspection. Removal of the neck resectate en bloc and, if dry and completely evacuated, insertion of a moist abdominal drape and turning to the opposite side. The procedure is basically exactly the same here. Exposure of the sternocleidomastoid muscle, omohyoid muscle, exposure of the submandibular gland with resection of the caudal part of the capsule. Exposure of the digastric muscle. Dissection of the anterior neck preparation with preservation of the superior thyroid artery and the hypoglossal nerve and with removal of the cervical artery. Dissection of the internal jugular vein, here a suspicious lymph node change measuring approx. 2 cm can be seen in the area of the jugulofacial angle, this is coarse on palpation, therefore clinically V.a. cN2c neck status. Visualization of the accessorius nerve. Complete exposure of the internal jugular vein. The facial vein is exposed and remains intact. Now clearing of the accessorius triangle and subsequent removal of level Va and level Vb. Finally, also dry conditions. No evidence of lymph leakage. Now turn to the laryngeal surgery. Exposure of the hyoid, detachment in front of the infrahyoid muscles, skeletonization of the larynx, exposure of the cricoid cartilage and the anterior surface of the trachea. Dissection of the thyroid isthmus and exposure of the anterior surface of the trachea on both sides. On the left side, detachment of the infrahyoid musculature, but here leaving a layer on the laryngeal skeleton in the case of thyroid cartilage infiltration. Now incision of the subperichondrium on the right side, detachment of the perichondrium on the inner surface while carefully preserving the pharyngeal mucosa. Now enter with the Mc Ivor spatula. Expose the vallecula. Performing the pharyngotomy in the area of the right vallecula. Widening of the pharyngotomy. Snaring of the epiglottis. Incision along the aryepiglottic fold towards the postcricoid region. Now complete overview of the tumor. Tumor extension as described above with deep ulcerated tumor in the area of the left piriform sinus well defined. Regular mucosal conditions in the marginal area. Somewhat granular mucosal conditions in the area of the postcricoid region, therefore choose a larger safety distance and demonstration to <CLINICIAN_NAME>, who recommends a sparing resection in the area of the postcricoid region, otherwise coordination of the procedure. Further resection of the tumor on all sides with at least a 1.5 cm safety margin on all sides. Lateral to the tumor, removal of a soft tissue mantle, palpatorily no deep growth towards the soft tissues of the neck. In the meantime, tracheotomy has already been performed. Initially a visual tracheotomy. Re-intubation onto an LE tube. Now resection caudal removal of the tumor approx. 2-3 cm above the esophageal inlet. Removal of the trachea after previous snaring and removal of the resectate. The specimen now shows macroscopic removal in toto on all sides. ............. Hypopharyngeal carcinoma but now cover the tumor. Take contiguous mucosal samples over the entire resection area. These are thread-marked and later assessed in rapid diagnostics as completely free of tumor and dysplasia. A caudally tapering strip of mucosa is now visible, but with at least 4-5 cm of residual mucosa caudally to cranially. It was therefore decided to perform a primary reconstruction with the local mucosa. After palpation, perform a myotomy in the area of the upper oesophageal sphincter and insert an 8 mm provost prosthesis using the usual pull-through method with puncture about 1 cm caudal to the future tracheostoma edge and insertion of a nasogastric tube and meticulous mucosal suture with 3.0 Vicryl while inverting the .................... Caudal pharyngeal suture area and base of tongue on both sides, thin pharyngeal mucosa circumscribed on the right side, this is later reinforced with pharyngeal musculature with an overall well-preserved and strong tube. Now in the pharyngeal muscles and inversion of the submucosal pharyngeal suture. Finally, caudal suturing of the pharyngeal tube with the thyroid flap and final suturing of the infrahyoid muscles to the base of the tongue and over the pharyngeal sutures. The tracheostoma was sutured in place beforehand, with a second skin incision and circular suturing of the trachea. Finally, stable tracheostoma. Final wound inspection. Circumscribed meticulous hemostasis with generally dry wound conditions. Irrigation with Ringer's solution and, if the wound is dry, insertion of a 10 mm Redon drain and careful two-layer wound closure. Finally, reintubation to a 10-gauge tracheoflex cannula and completion of the procedure without any indication of complications. The patient received intraoperative intravenous antibiotics and Unacid 1.5 g; please continue this antibiotic treatment for 3 days postoperatively. The X-ray emesis was performed on the 8th postoperative day. Conclusion: Intraoperative R0 resected cT4a cN2c G3 hypopharyngeal carcinoma on the left. After receiving the definitive histology, presentation at our interdisciplinary tumor conference to plan adjuvant therapy.