After intubation and preparation by the anesthesia colleagues, a pharyngo-laryngoscopy is first performed to determine the expansion again. Entry with the Kleinsasser tube. Inspection of the inconspicuous oral cavity. An exophytic tumor process with the tumor mass primarily in the area of the vallecula and the lingual epiglottis, infiltrating it subtotally on the right side and centrally, starting at the right base of the tongue and the vallecula. Narrow margin of infiltrated tongue base on the right side, but here without deep infiltration. Tumor growth along the pharyngo-epiglottic fold in the direction of the pharyngeal side wall here circumscribed and in the direction of the aryepiglottic fold, in front of the ary excluding ary infiltration, no infiltration in the direction of the petiolus either. Now insertion of the Tors retractor and with good adjustability and good exposure of the tumor under control with the 30° optics resection and dissection of the tumor, taking a narrow margin of the base of the tongue with it. Resection in depth up to the pre-epiglottic fat. Complete removal of the epiglottis up to just before the petiolus. Superficial resection towards the side wall of the pharynx in the case of only circumscribed tumor extensions. Resection up to the arytenoid, circumscribed resection of the medial wall of the piriform sinus. Good control during preparation in depth and with macroscopic in sano resection now imaging of the tumor in the area of the mucosal margins as well as basally in the area of the epiglottis. These are free of tumor and dysplasia. Subsequently, careful wound inspection and, if the wound is dry, a tracheostomy is performed due to the extensive wound area and the expected postoperative dysphagia. To do this, make a horizontal skin incision at the level of the cricoid cartilage. Cut through the skin and subcutaneous tissue. Exposure and transection of the asymmetrically running anterior jugular vein, exposure and entry into the linea alba, lateral preparation of the infrahyoid musculature. Exposure of the cricoid cartilage, exposure of the anterior surface of the trachea. Dissection of the slender thyroid isthmus. Overall relatively low standing conditions with low standing larynx, therefore insertion between the 1st and 2nd tracheal ring. Creation of a wide tracheotomy after opening the trachea. Subsequent successive incision of the skin and subsequent problem-free reintubation to a size 9 low cuff cannula. Subsequent completion of the procedure without any indication of complications. Conclusion: Intraoperatively R0 resected, extensive cT2 G3 supraglottic laryngeal carcinoma on the right. Due to the extensive resection of the supraglottic structures, a significantly reduced swallowing prognosis is to be expected here. Prompt presentation to our colleagues in phoniatrics and subsequent joint treatment planning with regard to a functional laryngectomy if necessary. Initially, please feed via the existing PEG tube.