Dictation <CLINICIAN_NAME>: After induction and intubation by the anesthesia colleagues, the primary tumor is inspected again. This is done with the Kleinsasser tube under dental protection. Inspection of the inconspicuous oral cavity and the oral vestibule. The exophytic tumor begins in the area of the pharyngoepiglottic fold on the left side of the oropharynx. This moves via the pharyngoepiglottic fold to the epiglottis, clearly infiltrates this on the left side and grows here via the aryepiglottic fold towards the ary and also infiltrates this on the left side. In addition, growth into the left piriform sinus, which is tumorously displaced at least in the entrance area. The glottic level as well as the esophageal entrance and the right side are completely tumor-free. The PEG tube was therefore initially inserted. Insertion with the esophagoscope under laryngoscopic control. Easy advancement into the stomach. Excellent diaphanoscopy. Problem-free puncture of the stomach and subsequent insertion of the PEG tube using the usual thread pull-through method. Repositioning of the patient. Marking and preparation of a broad-based apron flap. Subplatysmal preparation and suturing of the flap for neck dissection of the left side. Exposure of the sternocleidomastoid muscle. Dissection and preservation of the external jugular vein. Exposure and dissection of the omohyoid muscle. Release of the submandibular gland and exposure of the digastric muscle. Level II shows an extensive lymph node conglomerate, clinically clearly corresponding to metastases, and also clinically clear metastasis on palpation in level IV at the transition to V lateral to the internal jugular vein. Release of the anterior neck preparation. The facial vein is infiltrated and is deposited at the jugular vein after ligation. Exposure and preservation of the cervical vein and hypoglossal nerve as well as the superior thyroid artery. Free dissection of the internal jugular vein, common carotid artery and vagus nerve. These can be dissected freely upwards. The internal jugular vein is reduced due to the ambient pressure in the lumen, but is clearly not infiltrated. Overall, highly volnerable metastases on dissection of the accessorius nerve. After exclusion of infiltration, vulnerable mass, but absolute in-sano resection in handling. Clearing and completion of the accessorius triangle and completion towards level V with careful protection of the cervical plexus branches. No evidence of lymph leakage caudally. Here, lateral to the vein, as already described above, also vulnerable and clinically suspicious lesion, which is removed dead. Subsequent left-sided dissection of the infrahyoid musculature and release of the pharyngeal tube on the prevertebral fascia. Dictation <CLINICIAN_NAME>: Neck dissection on the right. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the accessorius nerve. Then exposure of the cervical vascular sheath. Free preparation of the internal jugular vein and the facial nerve. Exposure of the hypoglossal nerve and the digastric muscle. Dissection of the neck preparation II a to V a, sparing the plexus branches. Exposure of the hyoid bone on the right side. This is not done on the left side, as the tumor may already be breaking through the soft tissues of the neck. Detachment of the oblique laryngeal muscles. Release of the piriform sinus. Careful release of the piriform sinus on the left side. This is only possible to a very limited extent so as not to cut into the tumor. Enter the pharynx just below the hyoid bone on the right side. Now you reach the posterior surface of the epiglottis. At the edge of the epiglottis, incise into the pharynx, extending the incision dorsally along the edge of the epiglottis. Inspection of the inside of the pharynx and the tumor region. Here it becomes clear that the tumor does not infiltrate the posterior pharyngeal wall, but only the lateral pharyngeal wall and the piriform sinus on the left side as well as the aryepiglottic fold and the pharyngoepiglottic fold and the arytenoid cartilage on the left side and the left side of the larynx. Now incise the mucosa along the edge of the epiglottis on the right side. Then incise along the right arytenoid cartilage and the postcricoid region. Release the piriform sinus completely and turn the larynx over to the left side. Release of the mucosa at the base of the tongue. Excision of the tumor borders with a safety margin of 1.5 cm. Finally, detachment and removal of the larynx below the cricoid cartilage. Before this, the trachea was opened and reintubation performed. Now take marginal samples from the esophageal entrance, pharyngeal side wall and base of tongue. All marginal samples go to the frozen section. Here R0 on all sides. The creation of a provox is dispensed with due to the patient's wishes. Now reduction of the insertion of the sternocleidomastoid muscle on both sides. Suture the pharynx in the usual three-layered manner. The pharyngeal suture must be performed with particular care in the area of the base of the tongue, as quite a lot of mucosa was resected here, but there is still sufficient mucosa to close the pharynx without tension. Before the pharyngeal suture, an esophageal myotomy was performed in the upper sphincter. Incision of the tracheostoma and two-layer wound closure after placement of two Redon drainage tubes. Continue antibiotics for 24 hours. Rötgenbreischluck on the 10th postoperative day, then diet build-up.  