First, pharyngoscopy and laryngoscopy again, showing the exophytic tumor, which runs from the interary area centrally over both vocal folds, the anterior commissure to the arytenoid region on the left. Overall, not a large voluminous tumor, but rather a very extensive flat finding, which makes a larynx-preserving procedure inappropriate. Cartilage infiltration in the area of the anterior commissure, at least from the inside, cannot be ruled out. Therefore, repositioning for surgical therapy. Skin disinfection. Sterile draping. Injection of a total of 10 ml Ultracaine 1% with adrenaline in the area of the planned incision. Then elevation of the apron flap and neck dissection on both sides. Start with the neck dissection on the left side: dissection of the sternocleidomastoid muscle, exposure and protection of the XI nerve. Dissection of the cranial border with exposure of the lower edge of the gl. submandibularis and the digaster muscle. Locate and dissect the omohyoid muscle. No macroscopically suspicious nodes. On this side, regions Ib-V are completely removed while preserving all non-lymphatic structures. Transition to neck dissection on the right side, here the procedure is carried out in the same way. Final demonstration of findings on <CLINICIAN_NAME>." Subsequent laryngectomy: Dissection of the suprahyoid muscles from the hyoid bone, which is completely skeletonized. Exposure of the superior chorda on both sides and release of this on both sides. Exposure of the thyroid gland on both sides, transection of the isthmus. Thyroid gland is dissected caudo-laterally on both sides. Infrahyoid muscles are detached from the hyoid bone and beaten downwards. Constrictor muscle, pharynx with pharyngeal tube is dissected away from the pharyngeal skeleton as far as possible. Tracheotomy is then performed. Re-intubation. Then enter the larynx in the area of the epiglottis. The area of the lingual epiglottis mucosa is spared as far as possible. Then successive release of the larynx with maximum preservation of the pharyngeal mucosa. Separate the laryngeal skeleton from the pharyngeal tube up to the beginning of the trachea. Here the larynx is set down in a typical manner. In the case of subglottic growth, creation of the tracheostoma in the typical manner. Larynx is sent in for frozen section, here in frozen section cranial and caudal in the area of the mucosal settling points or trachea and epiglottis in sano. Subsequently, myotomy on the left side in the typical manner. The muscles of the pharyngeal tube are severed. Then separation of the sternocleidomastoid muscle in the area of the medial insertions on both sides. Then insertion of a 10 mm Provox prosthesis in the typical manner. This is positioned correctly. Then closure of the pharynx in a single layer using single button sutures. Further inverted suture in the second layer. Suturing of the pharyngeal tube or constrictor pharyngis and suprahyoidal muscles cranially, also using single Vicryl 3-0 button sutures. Then irrigation and careful hemostasis. Wound closure in layers with insertion of Redon drainage on both sides and epithelialization of the tracheostoma. Subsequent completion of the procedure without complications. Overall cT3-4 carcinoma endolaryngeal. Due to questionable cartilage infiltration to the front and the overall extension, laryngectomy was performed with neck dissection on both sides. Please feed via the inserted nasogastric tube for 8-10 days, then after swallowing gruel, if necessary, build up the diet. Please continue antibiotics, which were started with Unacid, for one week. After receiving the final histology, please attend the interdisciplinary tumor conference for further treatment planning.