Induction of anesthesia by the anesthesiologist. Intubation transnasally by the anesthetist. Entry with the flexible gastroesophagoscope and endoscopy into the stomach. Inconspicuous conditions on all sides. If diaphanoscopy is good, perform a PEG insertion using the thread pull-through method. Enter with the Kleinsasser tube and inspect the tumor region. There is an exophytic mass in the area of the left piriform sinus on the lateral and anterior wall. The medial and posterior border of the left piriform sinus is not covered by the tumor. The postcricoid and arytenoid region of the larynx is free on both sides. The vocal fold level and the pocket fold level as well as the epiglottis are also not affected by the tumor. It was therefore decided not to perform a complete laryngectomy. Now injection of xylocaine-adrenaline mixture in the throat area. Sterile washing and draping. Creation of an apron flap in the usual manner. Start with the neck dissection on the left side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle and the submandibular gland. It becomes clear that the sternocleidomastoid muscle and the internal jugular vein cannot be preserved on this side, so switch to the right side. Carry out the neck dissection on the right side to ensure that the internal jugular vein can be preserved here. Expose the sternocleidomastoid muscle, the omohyoid muscle, the digastric muscle and the submandibular gland. Exposure of the cervical vascular sheath. Free preparation of the internal jugular vein. The entire length of the internal jugular vein can be preserved, including the outlet of the facial vein and the facial vein itself. Exposure of the accessorius nerve and the superior thyroid. Release of the medial neck block and then release of the neck block II a to V a while sparing the plexus branches. This is successful without any problems. Then transfer to the opposite side and release of the medial neck block with detachment of a 5 x 3 cm metastasis in level II a. This is very difficult as the mass cannot be detached from the jugular vein. This is detached in the area at the border to level III. If the facial vein is very deep, the facial vein itself may remain intact. The sternocleidomastoid muscle must be partially resected and the accessory nerve must also be resected, as it runs directly into the tumor. The metastasis is now successively detached from the internal and external carotid artery. This can be done bluntly with the stalk to ensure that there is no infiltration of these vessels. Finally, the metastasis must also be bluntly detached from the vagus nerve and also from the hypoglossal nerve. Dissection in this area is generally very difficult. Ultimately, the metastasis is successfully detached from the nerves and vessels mentioned above and from the base of the skull. The remaining neck regions are then cleared out while sparing the remaining plexus branches. Entering the pharynx below the hyoid bone from the right side. Inspection of the tumor. This is localized as described above for pharyngoscopy. It is completely incised with a safety margin of 1.5 cm and is marked with a suture for the frozen section. The frozen section shows a complete R0 situation without carcinoma in situ, invasive carcinoma or dysplasia in the marginal area. As there is ultimately sufficient mucosa in the pharyngeal area, the decision is made to perform primary wound closure. This is usually carried out in two layers. As the mucosa is very thin in places and is somewhat under tension in some areas, the thyroid gland and the infrahyal muscles are stitched over the suture area. Finally, two Redon drains are inserted and a two-layer wound closure is performed. A tracheotomy was performed between the 1st and 2nd tracheal cartilage before the tumor resection. Creation of a visor tracheotomy without Björk flap. Epithelialization of the tracheal margins with the skin. Insertion of an 8 mm tracheal cannula. The patient is admitted to the intensive care unit in an awake state and should receive 3 days of intravenous antibiotics with Unacid and on the 10th postoperative day an X-ray vomit swallow, then if there is no fistula, removal of the nasogastric tube and implementation of the diet. Postoperative presentation of the patient at the tumor conference to plan adjuvant radiochemotherapy.