First pharyngoscopy and laryngoscopy: The exophytic tumor that was described can be seen starting laterally from the arytenoid fold and passing over the anterior piriform sinus wall onto the lateral piriform sinus wall. In addition, there is a flat, tumor-suspicious elevation, which has not been described before and is also tumor-suspicious. The decision was therefore made to cut around the entire area with a safety margin of at least 4-5 mm on all sides. Adjustment of the tumor with the spreading laryngoscope. Incision of the tumor with a distance of at least 0.5 to 1 cm on all sides. Resection extends laterally to the lateral wall up to the border of the posterior wall. It extends to the arytenoid fold, whereby the upper part is also resected, leaving the arytenoid cartilage free of mucosa. Resection extends over the most lateral part of the postcricoid region up to the vicinity of the tip of the piriform sinus. Cranially, parts of the vallecula and the base of the tongue are removed. Laterally, the pharyngeal wall is resected, but if the tumor is relatively flat, the musculature can be partially preserved. No fat prolapse at any point. The tumor is now marked with sutures. In the frozen section, in addition to the invasive carcinoma described, there is a second in situ carcinoma with a lateral margin. Thus indication for lateral resection. Once again, the tumor was positioned and an approx. 1 cm wide strip of mucosa was resected from the edge to the posterior wall via the lateral side wall to the vallecula area. Then take a marginal sample from the region described. This goes to the frozen section in 2 parts, lateral cranial belonging to the base of the tongue and lateral caudal belonging to the area of the posterior wall of the hypopharynx. No tumor infiltrates here. Thus now R0 situation. Now careful hemostasis. At one point, the musculature of the pharyngeal wall is slightly more severely damaged, but an outer part of the pharyngeal musculature remains in the direction of the large vessels. A tachosil fleece is placed here to secure it. No evidence of bleeding on final inspection. Due to the overall situation of the relatively large wound area with potential risk of bleeding and with regard to the removal of a protracted swallowing disorder, tracheostomy is now indicated. Repositioning of the patient. Injection of a total of 5 ml Ultracaine 1% with adrenaline. Sterile draping. Small Kocher collar incision. Dissection through the subcutaneous tissue into the infrahyoid musculature, which is split in the middle. Exposure of the thyroid isthmus. This is passed underneath, clamped off, severed and supplied with puncture ligatures. Exposure of the anterior wall of the trachea. Entering the 2nd intercartilaginous space. Creation of a wide pedicled Björk flap. This is epithelized in the typical manner. Finally, insertion of an 8 mm tracheal cannula. At the end of the operation, the site is checked again and there is no evidence of bleeding. The procedure is completed without complications. The patient should be fed via the PEG tube for at least one week, then carefully build up the diet and initiate swallowing training if necessary. Discuss further procedure in the interdisciplinary tumor conference.