Induction of anesthesia and intubation by the anesthesia colleagues. Entry with the flexible esophagoscope and inspection of the esophagus and stomach. No abnormalities here. With good diaphanoscopy, insertion of a PEG tube using the thread pull-through method. This is successful without any problems. Enter with the Kleinsasser tube and inspect the hypopharynx and larynx. The epiglottis on the right side shows an exophytic mass that affects both the lingual and laryngeal epiglottis and also crosses the midline. The exophytic mass extends over the aryepiglottic fold onto the arytenoid cartilage on the right side and upwards onto the vallecula. The sinus morgagni, the right pocket fold and the right vocal fold are also affected. Inspection of the hypopharynx. There are no abnormalities here. The hypopharyngeal side walls as well as the piriform sinus and the esophageal opening are clear. CT morphology revealed a thyroid cartilage destruction. Placement of a nasogastric tube and sterile washing and draping. Application of an apron flap in the usual manner. Start of swept head isulation on the right side and start of neck dissection on the right. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland. Exposure of the nervus accessorius, the internal jugular vein, the vagus nerve and the external and internal carotid arteries. Detachment of the cervical vascular sheath from the larynx. Ligation of the laryngeal artery and laryngeal vein. Transection of the superior laryngeal nerve. Isolation of the hyoid bone. Detachment of the hyoid bone from the muscles at the base of the tongue. Detachment of the infrahyoid musculature. A lot of tissue is left on the larynx due to the infiltration of the thyroid cartilage. Turning to the opposite side. Similar procedure. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland, accessorius nerve, cervical vascular sheath. Free preparation of the internal jugular vein. Detachment of the cervical vascular sheath from the larynx. Dissection of the laryngeal bundle. Detachment of the thyroid gland on both sides. Positioning for performing the tracheotomy. Insertion between the second and third tracheal cartilages. Creation of a mucocutaneous anastomosis in the anterior region. Re-intubation. Detachment of the hyoid bone from the base of the tongue on the left side and detachment of the infrahyoid muscles. Then detachment of the piriform sinus on the left side from the thyroid cartilage. This is successful without any problems. Turn to the right side. Here too, release the piriform sinus from the thyroid cartilage. Proceed very carefully here so that you do not get into the tumor. Perform the pharyngotomy from the left side. Disluxation of the epiglottis and incision of the mucosa along the edge of the epiglottis, initially on the left side up to the aryepiglottic fold and the arytenoid cartilage. Detachment of the larynx from the piriform sinus. Turning to the other side. Here, too, first proceed along the edge of the epiglottis to save mucosa. Then some of the pharynx must also be resected as it is permeated with tumor. Safety distance 1.5 cm to 2 cm. Detachment of the larynx below the cricoid cartilage. In the area of the base of the tongue on the left side, the resection appears to be relatively close, so a piece is resected here again and a final margin sample is taken. Marginal sample taken from the right pharyngeal mucosa and at the esophageal entrance. Pathology found no carcinoma cells or carcinoma in situ in any of the marginal samples. Therefore intraoperative R0 situation. Neck dissection is now completed on both sides with removal of the neck specimen from level II a to V a while sparing the plexus branches. Insertion of a voice valve prosthesis in the usual manner. This is successful without any problems. The pharyngeal suture is performed in two layers using single button sutures. A T-shaped suture is created at the base of the tongue and the infrahyoid muscles and some of the pharyngeal muscles are sutured over at the end. However, this is done very carefully so as not to constrict the pharynx. Before the pharyngeal suture, an esophagotomy was performed in the area of the upper esophageal sphincter. Incision of the base of the sternocleidomastoid muscle to achieve a flat tracheostoma. Placement of two Redon drains. Folding back the apron flap. Incision of the apron flap into the tracheostoma. Two-layer wound closure and insertion of a tracheostomy tube. The patient goes to the intensive care unit. Please no oral food for 10 days, then X-ray broad swallow and, if there is no fistula, food build-up in the usual way. After receiving the histology, the patient is presented to the tumor conference to plan adjuvant therapy.