After intubation and preparation by the anesthesia colleagues, the primary tumor region is inspected first. Entry with the Kleinsasser tube under dental protection. The oral cavity and oropharynx are inconspicuous, but with extensive post-radiogenic mucosal changes and significantly more difficult accessibility. In the area of the pharyngeal side wall already beginning on the oropharyngeal cavity, the ulcer described above is now visible, but the extension extends over the pharyngoepiglottic fold, also on the lateral free surface of the epiglottis and circumscribed on the right side on the vallecula. The base of the tongue itself is free, hardly any laryngeal adjustment is possible, but there is no extensive laryngeal infiltration. An attempt is now made to perform flexible esophagogastroscopy for PEG placement. Despite several attempts, this was not successful due to significant stenosis of the postcricoid region. However, there is no tumor here on inspection, so that PEG placement at this point must be dispensed with in the case of postradiogenic esophageal stenosis. A nasogastric feeding tube is now inserted, which is later surgically inserted into the oesophagus. The patient is then repositioned and prepared. Injection of xylocaine with added adrenaline. Cervical incision in the area of the old scar and curved anteriorly onto the larynx. Skin incision. Cut through the scars, the scars must be sharply detached. Pronounced post-therapeutic adhesions here. Detachment of the skin mantle. Exposure of the sternocleidomastoid muscle and successive retraction of the muscle. Laborious dissection of the cervical vascular sheath. Preservation of the internal jugular vein, common carotid artery and hypoglossal nerve. Successful dissection of the cervical vascular sheath from the pharyngeal tube. No signs of infiltration here. The pharyngeal tube is now released. The tumor tissue is already palpable in the area of the piriform sinus. After release of the pharynx on the prevertebral fascia, the hyoid is released. Half of the hyoid is entrained. Entering enorally in the area of the base of the tongue, here in sano conditions, but position above the vallecula portion of the tumor. In sano resection, a good half resection of the epiglottis, release of the laryngeal skeleton. Resection of the piriform sinus is not possible on the right side, here directly near the tumor. Therefore, resection is performed on approx. half of the lateral thyroid cartilage surface, but here a good overview is obtained. The tumor infiltrates the laryngeal skeleton via the anterior wall of the piriform sinus, the medial wall is again exposed. At this point, discussion of the findings with <CLINICIAN_NAME> regarding the selvage situation and oncological and functional indication for laryngectomy. Due to the extent described above and the corresponding patient information without an explicit laryngectomy discussion, the decision is now made to attempt to preserve the larynx. After complete release of all margins, the tumor is now resected with an adequate safety margin. Resection up to the posterior wall of the hypopharynx and up to the esophageal entrance. Macroscopically in the mucosal area in toto. The basally pre-described lateral site was covered by preparatory separation from the cervical vascular sheath, here further marginal sampling is not possible, however, removal of all lateral neck soft tissue and scar tissue by neck dissection. Complete coverage of the tumor in the mucosal area and explicit coverage of the remaining paralaryngeal soft tissue, here complete coverage of basal margin samples, as well as removal of margin samples in the area of the exposed thyroid cartilage. All marginal samples are diagnosed as carcinoma-free without high-grade dysplasia in the frozen section diagnostics, so that an R0 situation now exists and the preservation of the larynx can be confirmed. There is still an extensive defect. Due to the pronounced postradiogenic conditions and the already highly variable vascular situation during neck dissection, the indication for defect coverage using a pedicled pectoralis major flap from the right is given. Submammillary position of the flap. Measurement of an area of skin measuring 14 x 8 cm. Elevation of a passive deltopectoral flap up to the second agiosome. Strictly subfascial dissection and elevation of the deltopectoral flap. Incision of the pectoralis major flap. Fixation sutures to the muscle, strictly subfascial release. Exposure of the pectoralis minor muscle, exposure of the pedicle vessel, inclusion of a muscle cuff and isolation on the vascular pedicle with an excellently vital flap. Successive insertion of the graft without torquing. Careful suturing in the area of the esophageal entrance around the inserted nasogastric tube while widening the esophageal entrance. Suture to the larynx. Overall tight conditions with an excellent vital flap until the end of the incision. Positioning of the stalk. Subsequent careful wound inspection. Insertion of a 10-gauge Redon drain both cervically and twice pectorally with dry wound conditions. Adaptive cervical skin closure is then performed. Due to the course of the pedicle and the clear post-therapeutic scarring, complete wound closure is not possible despite mobilization of the neck skin, so the pedicle is left open over an area of approx. 6 x 6 cm and covered with Mepilex. Due to the slightly lowered conditions here, split skin coverage is not carried out at this stage. The granulation tendency should be awaited first. Adaptive cervical skin closure and strong wound closure in the breast area on all sides without increased tension. Subsequent completion of the procedure without any indication of complications. Conclusion: Intraoperative R0 resected ycT3 hypopharyngeal carcinoma on the right with circumscribed laryngeal infiltration. Due to the extent described above and the corresponding patient information, an intraoperative laryngectomy was deliberately avoided. However, due to the extensive resection, a significantly prolonged recovery or moderate prognosis with regard to swallowing function is to be expected. If there are no clinical signs of a pharyngeal fistula, an X-ray pre-swallow should be performed on the 10th to 12th postoperative day. Please continue intraoperative intravenous antibiotics for 24 hours.