After nasotracheal intubation by the anesthetist, pharyngoscopy again: The tumor is seen, which is located in the medial arytenoid fold and involves the anterior region of the piriform sinus. Growth in the direction of the arytenoid region and cricoid cartilage on the left with thyroid cartilage infiltration with thickening here in the area corresponding to the CT findings. Indication therefore confirmed once again. Skin disinfection and injection of a total of 10 ml Ultracaine 1% with adrenaline into both sides of the neck and sterile draping of all relevant surgical areas followed. Then first tracheotomy through <CLINICIAN_NAME>: horizontal incision and splitting of the prelaryngeal muscles, exposure of the cricoid cartilage and the anterior wall of the trachea. Undermining of the thyroid isthmus. Separation of the isthmus and suturing on both sides. Subsequent tracheotomy and fixation sutures of the inferior trachea. Re-intubation onto a laryngectomy tube. Widening of the skin incision and subplatysmal preparation of an apron flap. Suturing of the same. Start of neck dissection on the right and left side simultaneously with maximum vascular protection. Identical procedure on both sides. Subsequent neck dissection on both sides and laryngectomy with partial pharyngectomy. Creation of the apron flap in a typical subplatysmal manner. Start with neck dissection on the right side by <CLINICIAN_NAME>: exposing the anterior border of the sternocleidomastoid muscle. Locate and dissect the accessorius nerve, which runs deep to the internal jugular vein. Dissection of the digastric muscle. Dissection up to anterior to the hyoid bone. Expose and, after consultation, dissect the omohyoid muscle. Exposure of the cervical vascular sheath and visualization of the vagus nerve. Removal of the lateral neck preparation while preserving the plexus branches. Preservation of the submandibular gland. Evacuation of level II a and ligation of the superior thyroid vein. Neck dissection on the left by <CLINICIAN_NAME>. Exposure of sternocleidomastoid muscle, omohyoid muscle and digastric muscle. Showing internal jugular vein, internal, external and common carotid artery. Visualization of the vagus nerve, hypoglossal nerve and accessorius nerve. Successive evacuation Level II to V a. Branches of the cervical plexus are preserved. The result is an evacuation level II to V a. Some enlarged lymph nodes, no signs of perinodal spread, at least clinically. Subsequent laryngectomy and partial pharyngectomy by <CLINICIAN_NAME>: First visualization of hyoid bone. Separation of supra- and infrahyoid muscles. Exposure of the left superior cornu. Here, however, the pharynx is not separated from the superior cornu due to the situation of the hypopharyngeal carcinoma. On the right side, the pharyngeal tube is separated from the superior cornu and the piriform sinus is exposed. Then dissect the infrahyoid musculature and thyroid tissue from the larynx and cut caudally. Cranial dissection through the perilymphatic fatty tissue. Exposure of the epiglottis from the outside, opening of the larynx. Successive development of the larynx to save mucosa, especially on the right. The tumor is visible on the left side. Incision with at least 1.5 cm safety margin on all sides. This results in a partial pharyngectomy on the left, whereby the side walls and also the postcricoid area can be well preserved. Further development of the larynx. Then caudal placement in the area of the tracheotomy, whereby the trachea is extended dorsally for insertion. Removal of the larynx. Marking of the specimen. Sending in for frozen section marked with suture. In addition, a marginal sample is taken from the left side of the tongue base transition pharyngeal wall on the left in the cranial region. Both marginal sample and specimen without evidence of tumor in the marginal area or in the marginal sample. Therefore now R0 situation. Now palpation of the esophageal entrance. Wide conditions here, a myotomy can be omitted. Subsequent insertion of a 10 mm Provox prosthesis in a typical manner without complications. Then irrigation of the surgical site and hemostasis. Wound closure of the pharynx using 3.0 Vicryl single button sutures as 1st suture inverting. Then 2nd suture inverting over the 1st suture, also with 3.0 Vicryl single-button sutures. The 3rd suture is the suture of the musculature in the area of the constrictor pharyngis, if still present, or also with the supraglottic musculature where possible. Subsequently, extensive irrigation of the wound area. Hemostasis. Wound closure in layers with epithelialization of the tracheostoma and insertion of Redon drainage tubes on both sides. Finally, insertion of a 10 mm tracheostomy tube. The procedure was completed without complications. Overall cT4a hypopharyngeal carcinoma on the left with ingrowth into the laryngeal area with infiltration of the thyroid cartilage or the area between the arytenoid cartilage and the cricoid cartilage. Laryngectomy therefore also necessary. Neck dissection performed on both sides Level II to V. Postoperative nutrition via the inserted gastric tube. Gruel swallowed after approx. 10 days, then diet build-up. Please continue antibiotics for 1 week with Unacid, as already started preoperatively. Postoperative presentation at the interdisciplinary tumor conference.