In the patient, an extensive hypopharyngeal carcinoma with laryngeal infiltration was histologically confirmed as a squamous cell carcinoma during a panendoscopy, and a tracheotomy was performed in the presence of extensive edema. Overall difficult visualization of the tumor borders. CT showed hypopharyngeal carcinoma with extensive destruction of the larynx on the left side and also cN3 metastasis with a long wall around the ACC without definite signs of infiltration. A preoperative occlusion test showed a regular and sufficient collateral circulation. After extensive internal clarification and therapy optimization in the multimorbid patient as well as after detailed explanatory discussions with reduced therapy options, the decision was made to perform primary radical surgery.