Moving the patient to the operating theater. Actively carrying out the team time-out. Active patient identification. Introductory consultation with the anesthesia department. Induction of intubation anesthesia by colleagues. Positioning of the patient by the surgeon. First, laryngoscopy and pharyngoscopy again: After insertion of the small bore tube, the exophytic tumor, which begins in the area of the piriform sinus lateral wall at the transition to the anterior wall and infiltrates the medial wall including the arytenoid area and postcricoid area, is broad-based. Therefore indication for the above mentioned surgery confirmed. Repositioning of the patient by the surgeon. Injection of 20 ml Ultracaine 1% with adrenaline into the region of the planned apron incision. Start the operation by drawing the apron flap on both sides of the anterior edge of the sternocleidomastoid muscle to just below the cricoid medially. Separation of the cutaneous-subcutaneous tissue and platysma. Subplatysmal dissection up to the exposure of both submandibular glandulae. Suture the apron flap and expose the anterior border of the sternocleidomastoid muscle on both sides. Start with neck dissection, initially on the right side by <CLINICIAN_NAME>. Expose the anterior border of the sternocleidomastoid muscle. Dissection down to the deep plexus branches. Exposure of the accessorius nerve and free preparation of the nerve. Particular care is taken to protect the nerve. Exposure of the posterior venter of the digastric muscle and the submandibular gland. Dissection of the internal jugular vein and division of the specimen into a lateral and a medial specimen. Identification of the common carotid artery and the vagus nerve. Sharp separation of the neck dissection from the cervical vascular nerve sheath. Release of regions II, III, IV and V in one cord. Renewed wound control. Hemostasis using bipolar coagulation forceps. Approach the medial part of regions II and III by exposing the facial vein and the submandibular gland. A larger lymph node metastasis in the jugulofacial angle is removed here. Irrigation with hydrogen and Ringer and bipolar coagulation of minor bleeding. Turning to the left side. Same procedure through <CLINICIAN_NAME> on the left side. No primary suspicious lymph nodes are conspicuous. On the left side, also visualize all levels while sparing the vascular and nervous structures. Then proceed to laryngectomy with partial pharyngectomy on the right. Skeletonization of the pharynx and laryngeal area is performed on both sides, on the right, taking into account the carcinoma in the hypopharyngeal area. First expose the hyoid bone on both sides and separate it from the suprahyoid musculature. Dissection up to the pharyngeal tube, including the pre-epiglottic fatty tissue. Exposure of the superior cornu. Isolation of the laryngeal skeleton with separation of the constrictor pharyngis superior, first on the left, then on the right, taking into account the hypopharyngeal carcinoma. The thyroid lobe is isolated and dissected caudolaterally. The isthmus is transected and treated with puncture ligatures. Trachea is opened and epithelialized caudally using several sutures. Re-intubation and insertion of a laryngectomy tube. The larynx is then opened. The larynx is developed under visualization. On the left under maximum tension of the pharyngeal wall, on the right parts of the pharyngeal wall must also be resected. The tumor is removed at a distance of 1-1.5 cm on all sides. The tumor extends to the postcricoid, especially on the right. The pharyngeal wall can be dissected caudally. The larynx is then deposited on the trachea. The tumor specimen is marked with sutures. Due to the postcricoid growth, a mucosal margin sample is taken from the right pharyngeal wall via the postcricoid region to the border with the left pharyngeal wall. This is thread-marked and sent as a frozen section for histology. Soft tissue is also removed between the trachea and pharyngeal wall or esophageal entrance and also sent for frozen section. In the frozen section between the right pharyngeal wall and caudal still isolated tumor. Soft tissue and mucosa postcricoid free. Therefore, another extensive resection in the area of the lateral pharyngeal wall and removal of another marginal sample, which extends from the right pharyngeal wall to the postcricoid. No more tumor infiltrates in the frozen section. Thus R0 situation. A gastric tube is now inserted to splint the pharyngeal suture. Subsequent left lateral myotomy. The musculature is transected over approx. 2 - 3 cm. Then insertion of an 8 mm Provox prosthesis in the typical manner. This is placed approx. 0.5 cm lower due to the soft tissue margin between the trachea and the esophageal tube. Careful hemostasis and irrigation with Ringer's solution or hydrogen. Wound closure of the pharyngeal tube in layers with the first inverting suture. Then second inverting suture on top. Finally, third suture of the pharyngeal muscles. Sutures each with 3.0 Vicryl. Subsequent suturing of the infrahyoid musculature, which was previously dissected from the hyoid bone and folded caudal-laterally. This is also done with 3.0 Vicryl single button sutures. Lymph nodes in the level VI area were previously removed with the laryngeal preparation. Then again irrigation and careful hemostasis. Wound closure in layers on both sides of the neck with insertion of a Redon drain in each case. Epithelialization of the tracheostoma. Finally, insertion of a 9 mm tracheostomy tube. The procedure was completed without complications. Overall cT4a cN2c laryngeal carcinoma. Patient transferred to the intensive care unit for monitoring. Please feed via the PEG tube already inserted beforehand. This for 10 days, then gruel and, if necessary, diet build-up. Please continue antibiotics with Unacid for one week. After receiving the final histology, presentation at the interdisciplinary tumor conference.