After anesthesiological preparation, the patient is again positioned and pharyngoscopy and laryngoscopy are performed. The large tumor is seen in the area of the postcricoidal section extending to the border of the esophageal entrance, but not infiltrating it. Due to the location and size of the tumor, laser resection does not make sense for functional reasons, as the indication for laryngectomy is now confirmed. Due to the location, it may also be necessary to cover the defect with a flap, especially in the direction of the esophageal entrance. Therefore, these regions are now also covered. First inject 10 ml of Ultracaine 1% with adrenaline into each side of the neck and cover sterilely. Subsequently apron flap in the typical manner. Neck dissection on the left: A large cranial lymph node conglomerate is seen. Radical neck dissection is necessary to remove this. Resection of the cranial and inferior sternocleidomastoid muscle and removal of the digastric muscle follows. The hypoglossal nerve moves into the tumor and cannot be preserved, nor can the accessorius nerve. The internal jugular vein is double ligated cranially and caudally. The common carotid artery is also dissected from the lymph node conglomerate cranially and medially. Relatively firm adherence here. However, it is possible to dissect the tumor macroscopically in healthy tissue. A marginal sample is taken from the area of the common carotid artery and internal carotid artery on the carotid artery wall and sent for frozen section. No clear tumor infiltrates in the frozen section. The vagus nerve and border cord can be preserved. Level II to V excision follows, partly including the cervical plexus. As part of the evacuation of the anterior neck, the facial nerve also had to be ligated. Neck dissection on the right by <CLINICIAN_NAME>, PJ: After creation of the apron flap, exposure of the omohyoid muscle, exposure of the submandibular gland, the accessory nerve, anterior border of the sternocleidomastoid muscle, posterior belly of the digaster, cervical vascular sheath. The anterior neck preparation is first performed and completely detached from the omohyoid and cervical vascular sheath, below the submandibular gland. This is then skeletonized and the posterior venter of the digaster muscle is traced. The cervical vascular sheath is now dissected from below so that the neck preparation can be folded laterally from II to V. Macroscopically clear metastases are removed. The facial vein is cut and ligated. Now the neck preparation is successively detached from level II b to V b after all borders have been exposed. The accessory nerve and the cervical plexus are preserved. Removal of the neck preparation without a chyle fistula. Punctual hemostasis. Slightly larger venous and arterial branches are treated by ligation. The ACE, ACI, ACC, internal jugular vein remain intact. Also the vagus and hypoglossal nerves. At this point, the operation is handed over to <CLINICIAN_NAME> to perform the layngectomy, placement of the Provox prosthesis and tracheostomy. Subsequent laryngectomy: First isolate hyoid bone. pre-epiglottic fatty tissue is retracted into the tumor preparation. Infrahyoid muscles are dissected caudally from the hyoid bone and cut caudolaterally. The superior chorda is isolated on both sides, the constrictor muscle is separated on both sides. Further dissection on the inner side of the thyroid cartilage on both sides. The thyroid lobe is dissected off caudolaterally on both sides. The isthmus is severed and treated with stitches. A tracheotomy is then created. Re-intubation. Now enter cranially at the level of the epiglottis. Incision of the epiglottis of the arytenoid fold. Incision of the tumor in the postcricoid area with a distance of at least 1-1 1/2 cm on all sides. Subsequent removal of the larynx at the trachea directly subglottically. Take a marginal sample from the caudal area towards the esophageal entrance. Diesel suture-marked for frozen section together with the entire tumor specimen. Cranial tumor infiltrates are still questionable in the frozen section, therefore a 1 cm wide resection is performed in the transition to the cranial epiglottis at the base of the tongue as well as a marginal sample, which is now tumor-free. Thus R0 situation in the area of the pharyngeal tube. Now myotomy on the left side up to the last fiber. Insertion of an 8 mm Provox prosthesis in the typical manner. Then decision to elevate a pectoralis major flap as the esophageal entrance would become too narrow after suturing and the swallowing function would no longer be intact. Therefore, the dimensions of the pectoralis major flap were measured. Length 8 cm, maximum width 6 cm. Marking on the chest wall. Axillary skin incision. Creation of a tunnel in the area below the deltopectoral flap facially. The tunnel is created up to the lower borders of the neck wound. Subsequent incision of the skin island and the underlying muscle. Repeated application of several shear sutures. Finally, develop the flap along the course of the pedicle up to the clavicle, always keeping it under control. Push the flap through. Successive suturing of the skin flap into the defect with 3-0 Vicryl single button sutures completely tension-free after loosening the anti-shear sutures. Musculature is stitched over it in a further row of sutures. This is done in particular towards the base of the tongue and laterally. Followed by careful irrigation. Hemostasis. Layered wound closure of the neck wounds with insertion of Redon drains and the thoracic wound also with insertion of 2 Redon drains. Epithelialization of the tracheostoma here too. Insertion of a 9 mm tracheostomy tube. A nasogastric tube was also inserted during the procedure. The procedure was completed without complications. Patient admitted to intensive care unit for monitoring. Postoperative continuation of the intraoperatively administered antibiotics with Unacid. Feeding via gastric tube for 10-12 days, then gruel and, if necessary, diet build-up. Wait for the final histology, especially in the area of the extensive tissue removal in the area of the common carotid artery. Overall presentation at the interdisciplinary tumor conference. In N3b status, radiochemotherapy should be given in all cases.