First, skin disinfection and infiltration with local anesthetic containing adrenaline. Then marking and setting of the apron flap, whereby the tracheostoma is included in the apron flap. Dissection of the apron flap cranially to beyond the hyoid bone. Now start with the neck dissection on the right side. Here, regions II to V are removed while sparing all non-lymphatic structures. However, a lymph node metastasis can be seen around the internal jugular vein, which can just be dissected away from the vessel in a healthy layer macroscopically. Identification and dissection of the superior thyroid artery, which must be removed at the upper thyroid pole. Then dissection of the carotid artery, which is dissected laterally from the laryngeal skeleton. Then incision of the constrictor pharyngis muscle at the lateral edge of the thyroid cartilage and release of the piriform sinus on the right side as far as possible. On palpation, the tumor also appears to have partially grown into this area. Release of the lateral horn of the hyoid bone and separation of the suprahyoid muscles up to the middle. Then cut the straight muscles of the neck, pass under the thyroid isthmus and expose the anterior wall of the trachea up to the already existing tracheostoma. Then transition to the opposite side. Similar conditions here in principle. However, it can be seen that the left neck is in principle a single large metastasis extending from region IIa to region V. This is also macroscopically dissected in a healthy layer of the internal jugular vein, which lies medial and ventral to the metastasis. Resection of the metastasis en bloc reveals the brachial plexus. In addition, the phrenic nerve can now be seen to pass through the middle of the caudal metastasis, so that it must be removed. The metastasis is then developed retroclavicularly from the caudal side. This exposes the thoracic duct, which is also opened. It is then grasped and ligated. Finally, the metastasis can be completely removed from the caudal side. The site of the thoracic duct is also ligated so that no further lymphatic leakage can be seen clinically. Then dissection of the superior thyroid artery, which is extremely small in caliber. Therefore, dissection of the external carotid artery cranially and identification and dissection of the facial artery, which is deposited on the mandible and beaten caudally and later used for anastomosis. The suprahyoid muscles are now also removed here. The large tumor is palpable in the area of the lateral hyoid horn and the piriform sinus, so that no further manipulations are performed here. Now dissect the lingual side of the epiglottis up to its upper edge. Cut the pharyngeal mucosa at the upper edge of the epiglottis and enter the pharynx, initially to the right along the upper edge of the glottis. This reveals the tumor on the left. This occupies the entire left pharyngeal wall, spreads to the larynx, spreads endolaryngeally and has already infiltrated the right arytenoid. The tumor is then successively removed on both sides under visual control with an appropriate safety margin. The entire left pharyngeal wall is resected. The resection continues caudally into the esophageal orifice before it can be carried out on the opposite side so that the larynx can then be removed ventrally at the lower edge of the cricoid cartilage. Circumferential mucosal margin sections are then taken from the remaining pharynx, all of which prove to be tumor-free. The small amount of muscle still present in the posterior pharyngeal wall on the left side is also biopsied in the form of marginal incisions, which also prove to be tumor-free. This leaves only a strip of mucosa approx. 2 1/2 to 3 cm wide on the posterior pharyngeal wall. A radial lobe graft was then removed from the left forearm, each 7 cm wide and 10 cm long. After placement of the radial lobe graft, it is sutured into the defect, with the stalk being diverted caudally. The radial artery is then anastomosed to the facial artery. Venous drainage takes place through 2 veins in the end-to-side internal mandibular artery. In the meantime, a 6 x 10 cm split-thickness skin graft is harvested from the right thigh and used to cover the left forearm. Finally, freshening of the tracheostoma by resection of the granulating altered skin. Folding back the apron flap and two-layer wound closure in the usual manner after applying Redon drains on both sides and a flap on the left in the area of the anastomosis. Re-intubation of the patient. Repeated check of the flap, which can be easily seen with a laryngoscope. End of the operation, transfer of the patient to anesthesia. Conclusion: Laryngo-pharyngectomy for large hypopharyngeal laryngeal carcinoma. Cervical metastasis on both sides and mainly on the left. Therefore resection of the phrenic nerve on the left as part of the metastasectomy. Very close relationship of the metastases to the internal jugular vein on both sides. Covering of the defect on the left forearm with split skin from the right thigh. Due to the caudal extension of the resection to the esophageal entrance, the insertion of a provox prosthesis was initially dispensed with, whereby the myotomy was already performed intraoperatively for a possible later secondary Blom-Singer puncture.