First of all, pharyngoscopy and laryngoscopy again: The tumor appears as described. Tumor relatively flat, but extending towards the left plica pharyngo epiglottica. Mainly located at the base of the tongue on the left paramedian side with extensions to both sides. Laser resection of the tumor now follows: tumor is adjusted alternately with spreading laryngoscope, tonsil retractor and retractor. Good exposure. Start with right lateral resection. Here removal of marginal sample. Then resection left lateral as on the opposite side with approx. 0.5 -1 cm distance to the microscopically visible tumor. Subsequently, a left lateral margin sample is also taken. Then removal of the tumor from cranial to caudal. The lingual epiglottis and vallecula are also resected caudally. Removal of the tumor in one piece. Suture marking of the tumor with several sutures. Sending for frozen section. Tumor completely removed in sano. Also marginal samples in sano, thus overall R0 situation. Careful hemostasis. PEG placement, tracheostomy placement and neck dissection on both sides by <CLINICIAN_NAME>. Subsequent decision to perform flexible esophagogastroscopy for PEG placement in the typical manner. Insertion of the endoscope up to the stomach and placement of the PEG tube using the thread pull-through method in the typical manner. Now perform a plastic tracheotomy. Make an incision directly below the level of the cricoid cartilage, approx. 3 cm long. Cut through the subcutaneous tissue. Expose the prelaryngeal musculature and push it aside. Exposure of the anterior surface of the thyroid isthmus. Undermining of the thyroid isthmus. Separation of the thyroid muscle and ligation of both thyroid stumps. Exposure of the anterior wall of the trachea. Creation of an incision between the 2nd and 3rd tracheal cartilage clasp. Creation of a Björk flap in a typical manner. Epithelialization of the tracheostoma and reintubation with a size 8 Rügheim cannula. The patient is then repositioned for a neck dissection, initially on the right side. Creation of an incision along the anterior border of the sternocleidomastoid muscle. Cut through the subcutaneous tissue. Separation of the platysma. Formation of a platysma flap and exposure of the anterior margin of the sternocleidomastoid muscle. Dissection along the anterior margin. Exposure of the accessorius nerve. Exposure of the digastric muscle cranially and the omohyoid muscle caudally. Exposure of the internal jugular vein. Dissection along it and dissection along the cervical vascular sheath. Successive removal of the posterior neck preparation while sparing the above-mentioned structures. Protection of the plexus branches. Subsequent successive removal of the anterior neck specimen. Hemostasis using bipolar coagulation. Removal of the capsule of the submandibular gland. Exposure in the depth of the hypoglossal nerve. Exposure and protection of the cervical sinus. Creation of a Redon drainage. Two-layer wound closure. Now repositioning of the patient to perform a neck dissection on the left side. Identical procedure here. Creation of a skin incision along the anterior border of the sternocleidomastoid muscle. Cut through the skin, the subcutaneous tissue and the platysma. Exposure of the anterior border of the sternocleidomastoid muscle. Dissection along the same. Exposure of the nervus accessorius, the digaster muscle and the omohyoid muscle. Exposure and removal of the capsule of the submandibular gland. Successive evacuation of the posterior neck preparation in a typical manner, sparing the deep plexus branches. Exposure of the hypoglossal nerve between the internal jugular vein and facial vein. Successive removal of the anterior neck preparation. Hemostasis using bipolar coagulation. Creation of a Redon drainage. Two-layer wound closure. Application of a pressure dressing and completion of the procedure without complications. Nutrition for at least 1 week via an inserted PEG tube, followed by a cautious attempt to rebuild the diet and, if necessary, initiation of swallowing training. Further procedure after final histology, discussion of adjuvant therapy at the interdisciplinary tumor conference.