Dictation <CLINICIAN_NAME>: After induction of anesthesia and intubation by the anesthesia colleagues, the primary tumor area is first inspected using the Kleinsasser tube under dental protection. An exophytic tumor process with infiltration of the epiglottis can be seen starting at the free edge of the epiglottis on the right. The tumor continues across the aryepiglottic fold to just before the ary, a satellite focus is located slightly distant on the arytenoid mucosa, the main tumor mass is located in the right piriform sinus, which is subtotally filled, but the tip of the piriform sinus and the transition to the posterior wall of the hypopharynx are again tumor-free. Overall, there are clear perifocal extensions with a clearly uneven mucosa. Due to the extent, extensive cT2 with confirmed epiglottis infiltration cT3 tumor. Due to the size of the expected defect and the risk of pharyngo-cervical fistulization as well as the functional deficit due to the wound surface, the decision is made to proceed primarily transcervically with defect reconstruction. The patient is repositioned for this. First perform flexible esophagogastroscopy to insert the PEG tube. Enter with the gastroscope under laryngoscopic control. If the diaphanoscopy is good, the stomach can be punctured without any problems. Subsequent insertion of the PEG tube using the usual thread pull-through method. Injection of xylocaine with added adrenaline, starting with the right side. Cervical cutting of skin and subcutaneous tissue along the anterior edge of the sternocleidomastoid muscle. Exposure of the omohyoid muscle, the digastric muscle and the submandibular gland. The facial vein is exposed and ligated. Clearing of the anterior neck preparation with careful protection of the superior thyroid artery, the hypoglossal nerve and exact location of the superior laryngeal nerve, prolonged exposure and tracing and preservation of the nerve beyond the tumor resection. The internal jugular vein and the common carotid artery are now exposed. A metastasis-highly suspicious lesion can be dissected from the surrounding area, several suspicious lesions along the internal jugular vein. Exposure of the accessorius nerve. Excision of the accessorius triangle and level V, carefully preserving the transverse cervical artery of the cervical plexus and the vagus nerve. In toto removal of the neck preparation with in sano resection of all metastasis-suspected lesions. The thyroid cartilage is now released on the right side with dissection of the piriform sinus and visualization of the hyoid. Enter at the level of the right-sided vallecula. Widening of the pharyngotomy. Successive resection with 2/3 resection of the epiglottis, resection of the right aryepiglottic fold, resection of the arytenoid mucosa, leaving the intact joint intact. Subtotal resection of the right piriform sinus, the tip can be preserved. Resection up to the border of the posterior wall. After removal of the tumor, the specimen shows a somewhat scarce area basally, corresponding to the pre-epiglottic fatty tissue. This tissue is therefore completely resected. The specimen is thread-marked and sent for definitive histology together with the resected specimen. The invasive carcinoma is resected on the specimen R0, also in the basal section, only in the area of the pharyngeal side wall up to the cranial side is there a long stretch of Cis, so that an extensive resection is now carried out here. Renewed coverage with a mucosal margin sample, which was found to be completely free of tumor and dysplasia in the frozen section diagnostics, so that an R0 resection can be assumed. Measuring the defect and initially turning to plastic tracheotomy. Now turn to plastic tracheotomy. In the case of a post-thyroidectomy, use the old skin incision approx. 1 cm below the cricoid cartilage, cut through the skin and subcutaneous tissue. Removal of scars, exposure of the cricoid cartilage and the anterior surface of the trachea, insertion between the 2nd and 3rd tracheal ring, creation of a broad-based pedicled Björk flap and successive insertion of the tracheostoma. Neck dissection of the left side is then performed in parallel with radialis graft removal. For neck dissection: skin incision on the anterior edge of the sternocleidomastoid muscle. Separation of skin and subcutaneous tissue, dissection of the platysma, exposure of the sternocleidomastoid muscle, omohyoid muscle, digastric muscle, submandibular gland, removal of the anterior neck preparation with careful protection of the cervical artery, facial vein and superior thyroid artery. Free preparation of the cervical vascular sheath with exposure and protection of the vagus nerve, exposure and protection of the accessorius nerve, removal of the accessorius triangle and level V with careful protection of the cervical plexus branches. Overall, no suspicious nodules here, so that after final wound irrigation with Ringer's solution and dry wound conditions, a 10-gauge Redon drain was inserted with careful two-layer wound closure. Dictation <CLINICIAN_NAME>: Removal of the forearm flap to cover the right hypopharyngeal defect. Mark the size of the defect, which is 6 x 8 cm. Then mark a skin monitor approx. 1 x 2 cm slightly proximal to the graft. Incision of the skin. Exposure of the brachioradialis muscle with exposure of the cephalic vein. Removal of the graft subfascially from the ulnar side. Exposure of the superficial venous system and removal of this. Exposure of the superficial ramus and radial nerve. Locating the radial artery. Clamping and ligation of this. Further removal of the radial and subfascial flap. Further subfascial dissection and elevation of the radial artery flap along the pedicle. Smaller outgoing vessels are bipolarly coagulated and treated, larger ones are clipped. In the elbow area, extension of the skin incision and exposure of the radial artery, radial vein, cephalic vein and inter cubital vein. The flap is removed. The veins are ligated and the radial artery is sutured with a 6-0 Vascufil suture. Irrigate the flap with heparin solution.  