Introductory consultation with the anesthesiologist. Inspection of the hypopharynx on the left side with the size C small bore tube. The tumor described above is unchanged in size, which predominantly extends to the lateral wall of the hypopharynx and slightly to the piriform sinus wall. Otherwise there is no tumor. The medial piriform sinus wall is certainly not affected by the tumor. Removal of all instruments. Repositioning of the patient for tumor resection. Injection of local anesthetic with adrenaline along the sternocleidomastoid muscle. Incision with cutting around a platysmal flap. Dissection of the platysma and the platysmal flap. A large lymph node conglomerate can be seen laterally and on the vein, which extends to the vein angle. This is dissected down from the vein. The cranial part shows that the vein is clearly infiltrated by the tumor, which is why the decision is made to resect the vein. Therefore, long dissection of the vagus nerve and the carotid artery. Exposure of the internal jugular vein at the base of the skull. Ligation of the internal jugular vein at the base of the skull and detachment of the vein. This also releases the large lymph node conglomerate. Subsequent removal of levels I b, II, III, IV and V. It can also be seen that the caudal part of the accessorius nerve is infiltrated by lymph node metastases as it passes through to the trapezius muscle. Resection of the nerve here as well. The nerve is preserved in the cranial part in the innervation area of the sternocleidomastoid muscle. Long-term dissection of the nerve here. Displacement and re-embedding at the end of the operation in the sense of neurolysis. Preservation of the plexus branches during dissection. Release of the larynx. Release of the pharynx. Resection of the lateral part of the thyroid cartilage. This provides a good view of the pharynx. Separation of the constrictor pharyngis. Opening of the pharynx lateral and caudal to the tumor. From here, under good visibility, cut around the tumor with a macroscopically sufficient safety margin. Remove frozen sections after assessing the specimen. These are still declared tumor-free intraoperatively. Therefore pharyngeal suture with single button sutures. Closure of the constrictor pharyngeal muscle with continuous sutures. As the pharynx could be closed with local mucosa without tension, suturing of the platysmal flap was not necessary. Repositioning of the platysmal flap. Multi-layer wound closure. Insertion of a Redon drain. Application of a pressure dressing. Final consultation with the anesthetist. Completion of the procedure. Note: PEG placement may need to be discussed with the patient. This was not possible under gastroscopic view due to the extensive previous operation on the abdomen. Further procedure after receipt of the final histopathological findings and performance of the neck dissection on the right side. Discussion of the findings in the interdisciplinary tumor conference.