First, pharyngoscopy again. The exophytic tumor is seen, which is located in the pharyngeal side wall and in the piriform sinus on the front right and is fixed to the hemilarynx on the right. Confirmed in conjunction with CT above mentioned surgery. Patient was also informed about the use of a radial flap to cover the defect if necessary. First injection of a total of 10 ml Ultracaine 1% with adrenaline into both parts of the neck. Then sterile draping. Create the apron flap subplatysmally in the typical manner. Veins are bipolized and ligated. Dissection of the apron flap up to the level of the hyoid bone or the submandibular gland. Then neck dissection modified radical right: exposure of the digastric muscle, exposure of the omohyoid muscle. Exposure of the cervical vascular sheath. V. jugularis interna, A. carotis interna and externa. Exposure of vagus nerve, accessorius nerve, hypoglossal nerve. The latter must be pushed away from the tumor block, which is successful. Subsequent evacuation level II-V while preserving the branches of the cervical plexus. Neck preparation can be dissected away from the tumor, no per continuitatem growth. The upper pole of the thyroid gland was removed with the tumor specimen, the lower edge parts can be preserved, the thyroid gland was treated with puncture ligation. The superior thyroid artery was cut and ligated. Then modified radical neck dissection on the left: Basic procedure in the same way as on the left side. Exposure of the digastric muscle and omohyoid muscle here too. Exposure of the internal jugular vein, facial vein. Depiction of the common carotid artery, internal carotid artery, external carotid artery. Depiction of vagus nerve, accessorius nerve, hypoglossal nerve. All structures can be well preserved. A. thyroidea superior is dissected long towards the thyroid gland. The thyroid gland is deposited at the isthmus in such a way that a cystic nodule in the isthmus area is deposited together with the tumor specimen, with puncture ligatures on both adjacent sides. Exposure of the trachea. Evacuation of levels II-IV and parts of V. Retention of the branches of the cervical plexus. Subsequent careful hemostasis. Now tumor resection: separation of the infrahyoid muscles from the hyoid bone. Exposure of the upper horn of the thyroid cartilage on the left and dissection of the pharyngeal tube. Release of the piriform sinus. This is not possible on the right due to tumor growth. Thyroid gland is displaced caudo-laterally on both sides with exposure of the trachea from the side. Entry into the larynx on the left paramedian side after exposure of the epiglottis. The exophytic tumor is visible. This is resected on all sides with a safety margin of approx. 1.5-2 cm. Inclusion of the entire pharyngeal musculature. The upper pole of the thyroid gland is integrated into the tumor preparation. Left mucosa-sparing procedure as far as possible. Release of the larynx. Separation of the larynx from the trachea under incision, which extends the trachea cranially. Send in the entire specimen marked with sutures. Also send in 2 marginal samples in the cranial area mucosal marginal sample and cranio-basal. The entire specimen was removed in the healthy area. The cranial mucosal margin sample and the cranio-basal soft tissue margin sample are also healthy, thus R0 status. Overall, there is a defect extending not far from the esophageal entrance; cranially, the defect is connected to parts of the pharyngeal wall. Inspection revealed the possibility of closing the pharynx without a flap, hence the decision to proceed with this procedure. Myotomy first. A tear in the mucosa is seen slightly above the myotomy, which must be sutured. Inconspicuous conditions in the area of the myotomy. This improves the passage. Due to the overall tight mucosal conditions and the mucosal tear near the myotomy, a Provox prosthesis insertion is not performed intraoperatively in this case. The pharyngeal suture is performed. The first layer is performed between the remaining remnants of the pharyngeal wall and the adjacent tongue base tissue. This is done in two layers. The remaining pharyngeal mucosa can now be adapted to create a T-shaped suture. Inverting suture as the first suture. Then 2nd suture on top so that all layers are sutured in two layers. Sutures each with 3-0 Vicryl single button sutures. Third suture cannot be performed as there are no pharyngeal muscle remnants on the right. Hyoid bone was removed cranially to reduce tension. Infrahyoid musculature is sutured to the remains of the suprahyoid musculature using several adaptation sutures. Careful irrigation of the wound area again with H202 and Ringer's solution and careful hemostasis. At the end, the site is free of bleeding. Wound closure in layers and insertion of a Redon drain into both sides of the neck and epithelialization of the tracheostoma. Finally, insertion of a 10 mm tracheostomy tube. The procedure was completed without complications. Patient transferred to intensive care unit for monitoring. Please continue intraoperative antibiotics with Unacid for 2-3 days. Keep the patient fasting for 10 days, then swallow gruel and, if necessary, build up diet. Nutrition in the meantime via the inserted PEG tube. Please leave the feeding tube in place. If the healing process is normal, a Provox prosthesis can then be inserted secondarily. Overall cT4a cN2c hypopharyngeal carcinoma with invasion of the larynx. After laryngectomy and partial pharyngectomy, direct closure in borderline but low-tension conditions. Postoperative presentation of the patient to the interdisciplinary tumor conference.