Initially beginning with a pharyngoscopy and laryngoscopy. An exophytic mass is seen, starting at the pharyngo-epiglottic fold, which extends to the left arytenoid, infiltrates the entrance of the left piriform sinus and extends to the opposite side in the postcricoid region. Now imaging with narrow-band imaging and confirmation that laser resection is not possible here, even after consulting the CT findings. Then enter with the flexible oesophagoscope and pre-scan into the stomach. Here, conditions were unremarkable on all sides. Now perform the PEG insertion using the thread pull-through method with good diaphanoscopy. Then sterile washing and draping. Create an apron flap in the usual manner. Start with neck dissection on the left side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the digastric muscle of the submandibular gland. Then clearing of the neck levels IIa to Va while sparing the plexus branches and sparing the hypoglossal nerve and the accessorius nerve. Unfortunately, the lingual artery and the superior thyroid artery must be removed. Level IV shows a high-lying thoracic duct. This is partially injured during neck level removal and chyle flow occurs. In this case, the duct with the vein opening is cut off and covered with Tachosil. This is performed by <CLINICIAN_NAME>. Then turn to the opposite side and neck dissection on the right side. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland and digastric muscle. Clearing of the neck level while sparing the plexus branches of the hypoglossal nerve and accessorius nerve. The cervical vascular sheath was exposed and spared on both sides. The lingual artery can remain on the right side, but unfortunately the right superior thyroid artery must also be removed. The facial artery and ascending pharyngeal artery are still present on both sides and would theoretically still be available for a free flap transplant. Now release the hyoid bone and release the larynx by detaching the cervical vascular sheath and the thyroid gland from the larynx. Separation of the infrahyoid muscles and entry into the pharynx from the right side. Disluxation of the epiglottis and inspection of the tumor, which is as described above. Mucosal changes extend along the left hypopharyngeal side wall into the base of the tongue. Now incision of the mucosa at the edge of the epiglottis up to the postcricoid region and removal of the larynx, taking a large part of the pharynx on the left side with it. Initially, only a very narrow mucosal strip of the posterior wall of the hypopharynx remains. The esophageal opening itself is free and does not need to be resected. Marginal samples are taken. Here, extensive carcinoma in situ with partial transition to a microinvasive carcinoma can still be seen, particularly in the area of the left hypopharynx. Therefore, a resection must be performed here. Due to the resection, a complete pharyngectomy is performed in the caudal region. Extensive carcinoma in situ with partial microinvasion in the resected area. Therefore, further resection so that only a small amount of mucosa remains in the cranial and middle area of the hypopharynx and a transplant must be inserted in any case. After consultation with <CLINICIAN_NAME>, the decision is made to use a pectoralis major graft. A pro vox prosthesis is not inserted, even after consultation with <CLINICIAN_NAME>, as the pharyngeal reconstruction must be carried out completely with the pectoralis graft and there is no longer any mucous membrane capable of vibrating. Now lift the pectoralis major graft. To do this, measure the defect and lift and mark the graft 10 x 12 cm. A bridge is constructed in the area of the deltopectoral flap. The pectoralis major graft is lifted from the thoracic wall. Holding sutures are inserted and the graft is released, leaving the pedicle in place, and pulled upwards under the bridge. Mucosal sutures are then placed in the area of the esophageal inlet and also in the area of the base of the tongue and the cranial hypopharyngeal descending edge. The graft is then pulled in secondarily over the inserted sutures and knotted in place. The remaining parts of the remaining mucosa are connected to the graft to create a neopharynx through a tubed pectoralis major flap. A nasogastric tube was previously inserted for splinting. The stalk of the pectoralis major flap is positioned exactly on the chyle fistula so that it is also covered. Insertion of 3 redone drains in the thoracic region and one redone drain in each neck region. The patient is ventilated and admitted to the intensive care unit. Please continue postoperative antibiotics for at least 24 hours. Please provide fat-free nutrition with periamine for 3 days. Due to the size of the defect and the very large graft incision, there is a high risk of fistula, also because the pectoralis major flap is very large and has the lowest blood supply in the cranial area. If there is a risk of fistula, please open the neck and irrigate at an early stage. Otherwise, if there is no risk of fistula, take an X-ray vomit on the 12th postoperative day and carefully build up a diet. The patient must be presented to the tumor conference for planning of postoperative radiochemotherapy.