First, pharyngoscopy and larygoscopy again: The exophytic tumor is visible, which has not affected the hypopharyngeal side wall up to the midline, the anterior piriform sinus wall and parts of the arytenoid fold on the left. However, the arytenoid cartilage area and postcricoid area are free, as is the tip of the piriform sinus. Right piriform sinus also free, findings are demonstrated again <CLINICIAN_NAME>. Attempt to cover the defect using a platysmal flap or lateral thigh flap. Now first PEG insertion: advancement of the esophagoscope into the stomach, good diaphanoscopy after pre-operation and insertion of a 9-gauge abdominal wall tube without complications. Subsequent repositioning for neck dissection and tumor resection: injection of a total of 8 ml xylocaine 1% with adrenaline. Skin disinfection. Now first radical neck dissection with elevation of the platysmal flap. First mark the supraclavicular platysmal flap with a size of 9 x 5 cm. Then .............. the skin island and dissection of the flap pedicle with adjacent subcutaneous tissue, leading veins are preserved. The large infiltrating nodus can be easily dissected from a separating layer. Now dissect the sternocleidomastoid muscle, which is infiltrated by the nodule. Dissect the omohyoid muscle, the digastric muscle and the submandibular gland. The capsule of the gland is removed. The anterior neck area is now cleared out in the block. The carotid artery and vagus nerve, which are not infiltrated, are also exposed. Exposure of the internal jugular vein. This is infiltrated by the tumor node below the outlet of the facial vein, which is also dissected. It is therefore placed near the outlet to the facial vein and ligated twice. It is also removed caudally and ligated twice. The sternocleidomastoid muscle is removed anteriorly. First expose the accessorius nerve which is not infiltrated. Below the entry of the accessorius nerve into the sternocleidomastoid muscle, the muscle is removed cranially. This is followed by tumor resection via lateral pharyngotomy and partial pharyngeal-laryngeal resection: exposure of the pharyngeal tube, dissection of the constrictor pharyngis muscle. Exposure of the hypoglossal nerve, superior thyroid artery which is preserved and the superior laryngeal nerve which is also preserved. Thyroid gland is dissected away slightly caudo-laterally. Entering the larynx at the level of the hyoid bone, after exposing the tumor it is incised on all sides with a safety margin of approx. 1 cm. The piriform sinus is triggered by the thyroid cartilage. This is partially resected. Resection extends cranially to the level of the base of the tongue, medially to the epiglottis, the aryepiglottic fold is resected medially, the arytenoid cartilage remains in situ. The postcricoid area is not touched, the piriform sinus is resected anteriorly and laterally. Marginal samples are taken from the lateral pharyngeal wall, the medial pharyngeal wall, the arytenoid area and caudally from the piriform sinus. These are thread-marked and sent to the frozen section. In the frozen section, no reliable assessment or exclusion is possible medially in the pharyngeal region. All other marginal samples are tumor-free (<CLINICIAN_NAME>). Another marginal sample is therefore taken medially from the pharynx or epiglottis margin down to the arytenoid region. This is again thread-marked for frozen section. Now no more tumor tissue detectable (<CLINICIAN_NAME>). R0 resection can therefore not be assumed. The platysmal flap is now sutured into the defect. The flap has a good vital aspect before suturing. Suturing is performed using 3.0 Vicryl single button sutures without tension. The flap is then irrigated again with H202 and Ringer's solution and the bleeding is carefully stopped. The tracheotomy is performed: the incision is extended medially over the trachea. Then dissection up to the in..................... muscles, splitting of these, exposure of the trachea, isthmus barely present. Entry into the 2nd/3rd intercartilaginous space with creation of a visor flap and epithelization of this. Then skin displacement and wound closure on the left with insertion of a Redon drainage. Neck dissection on the right: skin incision in front of the sternocleidomastoid muscle. Dissection of the lymph node fat preparation from the muscle. Exposure of the omohyoid muscle, digastric muscle, internal jugular vein, carotid artery, vagus nerve and accessorius nerve. Development of the dorsal neck preparation and preservation of the branches of the cervical plexus. Then separate the anterior neck preparation, exposing and preserving the superior thyroid artery, the hypoglossal nerve and the cervical nerve. Irrigation with H202 and Ringer's solution and careful hemostasis. Wound closure with insertion of a Redon drain. Further reintubation, a tracheal cannula was inserted. Patient goes to the intensive care unit for postoperative monitoring. Patient received 3 g Unacid i.v. intraoperatively. Please continue this antibiotic treatment for one week. Please feed for 10 days via PEG or via the inserted gastric tube. After 10 days, please take an X-ray and, if necessary, rebuild the diet.