First pharyngoscopy and laryngoscopy: insertion of the Kleinsasser tube of medium size. The clearly exophytic tumor can be seen, which has consumed about 75% of the epiglottis, the tumor runs over the arytenoid fold onto the medial anterior and lateral wall in the area of the piriform sinus or pharyngeal side wall. Tumor does not appear to be optimally displaceable, particularly in the area of the vallecula, where infiltration is also evident; deeper growth is likely in the case of ulceration. The base of the tongue is not affected. In conjunction with the CT, where an infiltration of the pre-epiglottic space up to the hyoid bone is described and the proximity of the tumor to vessels, lymph node metastases. Decision to proceed primarily from the outside after discussing the findings with <CLINICIAN_NAME>. PEG insertion (<CLINICIAN_NAME>, <CLINICIAN_NAME>): Insertion of the esophagoscope in a typical manner. Advance into the stomach, where a 9-bore abdominal wall tube is inserted in the typical manner after a diaphanoscopy has been performed. Fixation of this. Then sterile draping, injection of a total of 12 ml xylocaine 1% with arenalin in the area of the neck on both sides. Then marking of a platysmal flap for possible defect coverage in case of pharyngeal wall infestation. Then elevation of an apron flap subplatysmal including the platysmal flap to be elevated. The platysmal flap is dissected in its skin island and lifted from the neck skin, including the subcutaneous tissue. However, dissection is not carried out up to the chin; this should only be done during the final flap suture. Dissection of the apron flap up to the level of the hyoid bone and submandibular gland on both sides. This is followed by radical neck dissection on the right: a large lymph node package is seen on the right. This is difficult to separate from the sternocleidomastoid muscle, so that the muscle is partially resected here. However, an actual infiltration is not recognizable. Depiction of the digastric muscle, omohyoid muscle. Depiction of the internal jugular vein. This appears clearly infiltrated after dissection of some lymph nodes in the middle area. Exposure of the vagus nerve, accessorius nerve and internal and external carotid artery. Depiction of the hypoglossal nerve. This can be dissected away from the lymph node conglomerate with some effort. Infiltrated internal jugular vein is resected in the middle area and double ligated cranially and caudally. Then develop the entire lymph node conglomerate together with the dorsal neck preparation, whereby some branches of the cervical plexus are also embedded in the conglomerate and must therefore also be resected. However, the most important branches including the phrenic nerve can be preserved. Subsequently, development of the anterior neck preparation with ligation of the superior thyroid artery. Then modified radical neck dissection on the left: Exposure of the omohyoid and digastric muscles as on the opposite side. Inclusion of the submandibular gland capsule as on the opposite side. Dorsal neck preparation is developed with exposure of the internal jugular vein, carotid artery, vagus nerve and accessorius nerve. Removal is performed while preserving all cervical plexus structures. Subsequent development of the anterior neck preparation as on the opposite side. The superior thyroid artery is preserved. The hypoglossal nerve is also exposed and preserved. Then tumor resection: separation of the suprahyoid muscles from the right to the paramedian left. Exposure of hyoid bone. Exposure of ..................... superior. Detachment of the constrictor pharyngis muscle. All soft tissue behind the hyoid bone up to the larynx is also resected. Entry into the left paramedian larynx. Exposure of the epiglottis. After cutting around the tumor with a safety margin of at least 1-1.5 cm on all sides. Part of the left pharyngeal wall up to the middle of the lateral wall and the entire supraglottic area including both aryepiglottic folds are removed, leaving the thyroid cartilage intact. Vallecula and caudalmost parts of the base of the tongue are also resected. Tumor clearly removed in healthy tissue. Tumor is thread-marked. Marginal samples are taken from the arytenoid region as well as a resection in the tongue base region and a marginal sample in the tongue base region. The marginal samples and the marked tumor specimen are sent for frozen section diagnosis. Tumor in healthy tissue removed at the preoparate, marginal samples also tumor-free. Thus R0 resection. This is followed by complete irrigation of the entire wound area with H202 and Ringer's solution and careful hemostasis. The lingual artery is prophylactically ligated on the right side and severed. The lingual artery and superior thyroid artery on the tumor side are ligated and severed. The superior laryngeal nerve is preserved on both sides. Reconstruction as after Alonso resection. The posterior dorsal pharyngeal wall areas are adapted on the left and especially on the right using 3.0 single-button Vircyl sutures so that the defect remains towards the thyroid cartilage. The piriform sinus entrance is preserved. The arytenoid cartilage is exposed on the right side. Soft tissue largely removed up to the thyroid cartilage towards the front. The thyroid cartilage is then sutured with several Vicryl 0 sutures so that the thyroid cartilage comes to lie under the hyoid bone. This ensures stable and complete closure of the defect. The infrahyoid musculature is then sutured back to the hyoid bone. Before the tumor resection, a tracheostoma was also created. Here, the thyroid isthmus was exposed in a typical manner, passed underneath, clamped and supplied by means of stab ligatures. A Björk flap similar to a virsier flap was then created and epithelized in the 2nd/3rd intercartilaginous space. This was followed by reintubation and insertion of a laryngectomy tube. The wound area was then irrigated again with H202 and Ringer's solution and careful hemostasis was performed. The wound was then closed in layers with epithelialization of the tracheostoma and re-suturing of the skin island of the platysmal flap. A Redon drain was inserted on both sides. Finally, reintubation and insertion of a 7-gauge tracheostomy tube. The patient received Unacid 3 g i.v. intraoperatively. Please continue this antibiotic treatment for one week. Please feed patient via PEG for 7-10 days. Afterwards, if necessary, gruel swallowing and diet build-up. Patient goes to the intensive care unit for postoperative monitoring.