Induction of anesthesia and intubation by the anesthesiology colleagues, followed by entry with the small bore tube and inspection of the hypopharynx and larynx. An exophytic tumor mass was found in the area of the right piriform sinus, filling the entire piriform sinus and growing submucosally in a cranial direction. The aryepiglottic fold and the arytenoid cartilage on the right side are reached. The endolaryngeal pocket folds and vocal folds are tumor-free. The epiglottis is also tumor-free. However, the pharyngoepiglottic fold is also covered by the tumor. Esophageal entrance just clear. Then enter with the flexible esophagoscope and view into the stomach. No abnormalities here. PEG placement using the thread pull-through method with good diaphanoscopy - this was successful without any problems. Injection of Ultracaine in the neck area and sterile washing and draping. Then creation of an apron flap and start of neck dissection on the right side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digaster muscle. Then exposure of the nervus accessorius, the facial vein and the cervical vascular sheath. Free preparation of the internal jugular vein. Exposure of the plexus branches and removal of the neck preparation II a to V a, sparing the plexus branches. Exposure of the superior thyroid artery and the external jugular vein. Then release of the cervical vascular sheath from the larynx. Separation of the superior laryngeal nerve, the artery and the superior laryngeal vein. Detachment of the thyroid gland from the larynx and change to the opposite side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle and the submandibular gland. Then visualization of the facial vein and the internal jugular vein. Free preparation of the internal jugular vein. Then release of the medial neck block and visualization of the accessorius nerve and the plexus branches. Release the neck preparation II a to V a, sparing the plexus branches through <CLINICIAN_NAME> and <CLINICIAN_NAME>. Perform the tracheotomy. To do this, enter the trachea, after severing the thyroid isthmus, between the 2nd and 3rd tracheal cartilage and create a mucocutaneous anastomosis in the caudal region. Re-intubation and pharyngotomy on the left side. Disluxation of the epiglottis and incision of the mucosa along the edge of the epiglottis. The tumor can be seen as described above. The tumor is resected with a safety margin of at least 1 cm to 1.5 cm in the pharyngeal region. Unfortunately, nothing of the larynx can be preserved, firstly because the arytenoid cartilage is infiltrated on the right side and secondly because the thyroid cartilage is extensively infiltrated on the right side and cannot be detached from the pharynx and the tumor at all. On the left side this was achieved without any problems. Now successive excision of the tumor, taking the laryngeal preparation with it. Removal of the larynx below the cricoid cartilage. It then becomes clear that the resection in the area of the esophageal entrance was very close, a large resection is taken here and then a final marginal specimen is taken again. At the upper edge of the thyroid cartilage, the tumor is growing towards the soft tissue; here, too, the resection was very close. However, there is still a very thin, muscular displacement layer above the tumor. To be on the safe side, the infrahyoid musculature, which is located directly at this site, is resected again extensively and thickly and sent for final histology with a thread marker. The specimen is thread-marked and sent to the frozen section. In the frozen section, overall R0 situation, including the final edge sample at the esophageal entrance, this was discussed by telephone with the pathologists, a resection was not necessary at any point. A myotomy of the upper esophageal sphincter was performed. Now lifting of the radialis graft, 13 x 7 cm. Unfortunately, primary closure cannot be performed in the pharyngeal region as too little mucosa remains. The radialis graft is lifted in the usual way. First cut around the skin. Incision of the skin along the forearm up to the crook of the elbow. Then expose the venous star with the superficial venous system and locate the venous confluence with the deep venous system. Visualization of the brachioradialis muscle. Visualization of the radial superficial ramus nerve. Exposure of the radial artery. Clamping of the radial artery under pulse oximetric control - here always 100% saturation on the hand. Dissection of the radial artery and detachment of the graft from the tendons. Then dissect the pedicle in the usual way and place the radial artery graft in the crook of the elbow. Two different veins are lifted, one from the deep and one from the superficial system with preserved confluence. The graft is then sutured into the pharynx, which is of course somewhat difficult in the area of the base of the tongue and also in the area of the esophageal entrance. A pointed Z-plasty is performed here to counteract any subsequent esophageal inlet stenosis. Sutures are placed in the esophageal entrance for this purpose. Finally, the transplant is inserted with a precise fit. Repositioning to perform the anastomosis. The arterial anastomosis is performed via the superior thyroid, the venous anastomosis via the facial vein on the one hand and the external jugular vein on the other. Insertion of 2 Redon drains. Folding back of the apron flap and completion of suturing to the tracheostoma. Two-layer wound closure. At the end, another Doppler check in the area of the anastomosis and marking of the venous limb and the arterial limb for postoperative Doppler control. At the very end, another transoral inspection of the graft. This shows a very good blood supply to the graft. The operation is completed without difficulty. The patient is ventilated in the intensive care unit and is allowed to wake up the following day. Continue antibiotics for 24 hours. X-ray gruel swallow on the 10th postoperative day. If there is no fistula, please build up the diet, in the meantime feed via the PEG tube.