First, pharyngoscopy and laryngoscopy again, tumour localization and extent confirmed. PEG insertion: Careful insertion of the flexible instrument into the stomach. Identification of the anterior wall of the stomach and observation of a positive diaphanoscopy. Abdominal wall puncture and PEG insertion in the usual manner using the suture pull-through method without complications. Subsequent repositioning for neck dissection on both sides and laryngectomy with partial pharyngectomy on the left. Apposition of the apron flap in the typical manner. Neck dissection on the right side and release of the larynx, tracheotomy and performance of the myotomy: repositioning of the patient for laryngectomy in the head reclination position. Injection of Suprarenin in the area of the skin incision (apron flap). Sterile wiping and draping of the patient. Start the operation by making a skin incision on both sides of the anterior edge of the sternocleidomastoid muscle to below the cricoid (apron flap). Separation of the cutaneous and subcutaneous tissue and subplatysmal flap elevation. After exposing the hyoid bone and the submandibular glandulae on both sides, the apron flap is sutured cranially. Transition to neck dissection on the right side by exposing the anterior border of the sternocleidomastoid muscle and sharp dissection down to the depths until the deep plexus branches become visible. Identification of the accessorius nerve and removal of the nerve from the neck preparation. Exposure of the posterior venter of the digastric muscle at the cranial end of the neck and dissection along the muscle to the hyoid bone. Now identification of the omohyoid muscle and dissection along the muscle also up to the hyoid bone. Insertion of the caudal retractor and exposure of the cervical vascular nerve sheath. The neck preparation is dissected free to the cervical vascular nerve sheath and removed from cranial to caudal in the usual manner while protecting the vascular and nerve structures. No suspicious nodules are detected during dissection. Identification of the carotid bifurcation and visualization of the superior thyroid artery. Separation of the superior thyroid artery close to the larynx. Separation of the infrahyoid muscles at the hyoid bone and dissection of the muscles caudally. Skeletonize the larynx in the usual manner. At the caudal end, remove and free the thyroid gland from the cricoid cartilage and the trachea. Now expose the thyroid isthmus, undermine the isthmus and cut the isthmus after bipolar coagulation. Entry into the trachea after saturation of the patient in the 2nd to 3rd intratracheal space. Re-intubation and suturing of the tracheostoma in the caudal region. Radical neck dissection on the left: A large lymph node or lymph node conglomerate is visible cranially, which extends to the large vessels. Successive dissection of the node away from the adjacent, neighboring structures. This is initially carried out cranially, taking the digastric muscle and the hypoglossal nerve with it, which run directly into the lymph node conglomerate. The accessor nerve and the cranial insertion of the sternocleidomastoid muscle are also resected cranially. Exposure of the vessels from the medial side. The facial vein is ligated. The internal jugular vein is also removed caudally and ligated twice caudally. Further dissection of the conglomerate cranially along the common carotid artery, later internally and externally. The bifurcation is dissected, here the tumor reaches directly, but it is possible to dissect a layer of adventitia and thus completely dissect the tumor from the internal carotid artery and out of the bifurcation. Further cranial infiltration of the externa. This is therefore removed shortly after the bifurcation and treated here using 4-0 prolene sutures. The external carotid artery is also removed cranially. The internal jugular vein is also removed, which is ligated twice cranially. The vagus nerve can also be dissected straight from the tumor, there is no direct tumor infiltration here, it can be dissected bluntly. Several branches of the cervical plexus must also be resected. The sternocleidomastoid muscle must also be removed caudally. The accessorius nerve is also removed. After removal of the main lymph node conglomerate, further neck dissection, ultimately level II to V. This involves partial preservation of the branches of the cervical plexus. Phrenic nerve preserved. Also border cord. Subsequent irrigation of the wound area and hemostasis. Laryngectomy follows: dissection of the suprahyoid muscles from the hyoid bone. Also dissection of the infrahyoid muscles from the hyoid bone, which is cut caudally. Skeletonization of the larynx on the right side, exposing the superior cornu. Detachment of the constrictor pharyngis muscle. Dissection of the thyroid glands latero-caudally on both sides. Separation of the isthmus here. Subsequent creation of a tracheotomy and insertion of a laryngectomy tube after reintubation. Then cranial exposure of the epiglottis from the outside. The epiglottis is isolated with maximum preservation of the mucosa. You now have a good view of the tumor. The tumor is resected with a safety margin of at least 1.5 cm on all sides on the left side of the pharynx. Maximum preservation of the mucosa on the right side. Subsequent release of the larynx in the area of the pharyngoesophageal junction. Then separation of the larynx from the trachea in a typical manner. Marking of the tumor specimen using sutures. To be on the safe side, a marginal sample is taken from the hypopharynx on the left from the area of the transition to the postcricoid up to the transition to the base of the tongue and is also marked with sutures for the frozen section. Overall, all specimens together indicate an R0 situation. The left myotomy now follows. The constrictor pharyngis muscle on the left side is successively severed up to the mucosa to facilitate passage through the pharyngoesophageal junction. Provox prosthesis insertion is then carried out by inserting an 8 mm prosthesis, which is inserted without complications and in a typical manner. Subsequent closure of the pharynx, which is easily possible in the first instance, by means of an inverting layer using 4-0 Vicryl single button sutures. A further layer of inverting sutures, also with 4-0 Vicryl single button sutures, is placed on top. A third layer can be applied cranially, but this must be omitted in the area of the pharyngeal tube due to the hypopharyngeal resection, which also involved the muscular wall. Caudally, the musculature of the omohyoid muscle is still sutured via the pharyngoesophageal junction, as is the thyroid gland. The wound area is then irrigated again and the bleeding stopped. Wound closure in layers with insertion of a Redon drain on both sides and epithelialization of the tracheostoma. Insertion of a 9 mm tracheostomy tube at the end. Completion of the procedure without complications. Patient transferred to the intensive care unit for monitoring. Overall cT2-3 hypopharyngeal carcinoma on the left. No larynx-preserving therapy indicated due to the overall situation and the expected dysphagia in the patient's condition, in particular the presence of COPD. Postoperative nutrition via the inserted gastric tube or PEG tube. This for 7 to 10 days, then gruel and, if necessary, dietary support. Due to the large mass on the left, postoperative RCT is certainly indicated adjuvantly. Tumor could be easily removed from the common carotid artery or bifurcation and interna after pushing off with the adventitia. Nonetheless, the lymph node conglomerate was also present on the internal carotid artery for a long time. Presentation at the interdisciplinary tumor conference after receipt of the final histology.