First laryngoscopy and pharyngoscopy: The large, exophytic tumor is visible, which extends to the midline of the posterior wall of the hypopharynx on the right and breaks into the larynx via the lateral wall/anterior wall. The tumor cannot be reliably demarcated caudally from the esophageal entrance. Due to the extent of the tumor, flap coverage is indicated in any case. Due to the uncertain vascular situation in the area of the forearms, bilateral coverage of the thigh area on the right. Start with neck dissection on both sides: creation of an apron flap in the typical manner up to the level of the submandibular gland and hyoid bone. Followed by neck dissection on the left. Detachment of the fat lymph node package from the sternocleidomastoid muscle. Exposure of the omohyoid muscle, digastric muscle. Exposure of the cervical vascular sheath, internal jugular vein, internal and external carotid artery. Exposure of the hypoglossal nerve, vagus nerve and accessorius nerve. Development of the dorsal neck preparation and preservation of the branches of the cervical plexus. Subsequent development of the anterior neck preparation and preservation of the hypoglossal nerve, facial vein and superior thyroid artery. Overall evacuation level II to V. Now radical neck dissection on the right: tumor conglomerate in the upper neck area infiltrates the sternocleidomastoid muscle and internal jugular vein. Therefore removal of the sternocleidomastoid muscle cranially and caudally. Separation of the accessorius nerve. Separation of the internal jugular vein and double ligation cranially and caudally by means of puncture and single ligation. Tumor conglomerate can be dissected from the common carotid artery and external carotid artery as well as the branches and the hypoglossal nerve. Detachment of the tumor from the external carotid artery branches and the subglottis is sometimes difficult. It can be seen that the tumor is connected to the thyroid gland. There is a risk of infiltration here. Therefore, the tumor conglomerate on the right lobe of the thyroid gland is left as a per continuitatem resection. The remaining level II to V areas are typically removed here. Subsequent tumor resection: First detachment of suprahyoid muscles from the hyoid bone including the pre-epiglottic fatty tissue. Detachment of the constrictor pharyngis muscle from the left superior cornu. Separating piriform sinus. Entering the pharynx cranially. Incision of the tumor with a safety margin of at least 1.5 m to 2 cm on all sides. Resection includes hypopharynx, a residual pharyngeal strip of 2 cm remains in the middle area. The tumor extends caudally to the esophageal entrance and is removed here with a safety margin of approx. 1 cm. The tumor is then removed caudally. Marginal samples are taken from the hypopharyngeal margin on the right and left and from the caudal margin in the area of the esophageal entrance. All marginal samples and the tumor are sent to the frozen section for assessment. Frozen section in the area of the esophageal inlet free. Infiltrates still in the area of the posterior wall of the hypopharynx. Here again resection and submission of a mucosal strip, which is thread-marked for frozen section examination. Here again in situ infiltrates buccally. Due to the small width of the remaining strip, which is less than 1 cm in some cases, the remaining pharynx is now resected from the transition to the oropharynx to the esophageal entrance. The resectate is suture-marked for final assessment. Total pharyngectomy and indication for flap coverage using a thigh flap. The thigh flap is now elevated: first mark the flap size, which is 11.5 cm in length and 10 or 8 cm in width. Also Doppler mark the perforators. The flap is drawn around the perforators. Then first cut around medially. Exposure of the rectus femoris muscle and vastus lateralis muscle. Subfascial dissection up to the intermuscular septum. Subsequent cranial exposure of the vascular pedicle. The ramus descendens and 2 accompanying veins can be visualized as well as 2 accompanying nerves that run into the vastus lateralis. No special features cranially in the vascular pedicle area. Then cut around the flap to the fascia from the medial side. The vascular pedicle is deposited caudally. Then successive elevation of the flap together with parts of the vastus lateralis muscle and preservation of the level of the septo-musculocutaneous perforators. Finally, perforation of the cross-section up to the exit from the profunda brachii artery. Here, the artery and a total of one larger and one smaller accompanying vein are removed. Proximal vascular stumps are ligated using puncture ligatures 400 Prolene. Finally, after careful hemostasis, wound closure in layers with mobilization of the skin and insertion of Redon drains. Primary skin closure is possible. The flap is then sutured into the defect. Flap is sutured into the defect using 3/0 Vicryl single-button sutures, in some cases after the sutures have been placed, initially caudally and then also cranially. Esophageal access plasty is performed caudally. A myotomy was also performed here beforehand. Passage is easily possible with a transverse finger. Anastomosis and pharyngoplasty are performed with little tension. Muscle parts of the vastus lateralis are placed over the suture of the flap. A larger outlet from the right external carotid artery and the right external jugular vein are then trimmed and conditioned. The vessels of the flap pedicle are also conditioned. The descending ramus is then sutured to the exit from the external carotid artery using 8/0 single-button ethilon sutures. Here, after opening the clamp, good venous return. The vein size is then measured. A 3/0 coupler is selected. This is used to create the anastomosis between the external jugular vein and the larger of the two veins of the flap pedicle. After opening the clamp, good reflux, alignment test positive. The remaining vein is clipped. The outflows from the external crus, which occurred after removal of the anastomotic vessel, are ligated. Overall good flap perfusion, good arterial flow and venous return. Careful hemostasis of the entire wound area is now performed. Irrigation. Then wound closure in layers with epithelialization of the tracheostoma and insertion of a Redon drain on each side. Subsequent marking of the vessels for Doppler control. Insertion of a tracheostomy tube, which is sutured in place. No dressing is applied. Patient goes to the intensive care unit for postoperative monitoring. The antibiotic treatment with Unacid 3 g started intraoperatively should be continued postoperatively for 1 week with 3 x 1.5 g i.v. nutrition via the PEG for at least 10 days, followed by gruel and, if necessary, a diet. The inserted gastric tube can then also be removed. Please continue heparin perfusor with 500 units per hour for 3 days. Overall, extensive hypopharyngeal tumor with invasion into the larynx and extensive lymph node metastasis, especially on the right side. Postoperative radio-chemotherapy is certainly indicated if the patient can tolerate it due to the concomitant disease.