Induction of anesthesia by anesthesia colleagues. Intubation by the anesthetist. First of all, entry with the small bore tube and inspection of the tumor region. An exophytic tumor is seen, starting in the tonsil loge on the right side, moving caudally, infiltrating the piriform sinus in the entrance area on the hypopharyngeal side wall. The tip of the piriform sinus is free, the tumor extends at the aryepiglottic fold onto the arytenoid cartilage on the right side. The endolarynx itself is free, but postradiogenically altered. Repositioning and placement of a PEG tube using the thread pull-through method. This is successful with good diaphanoscopy. No abnormalities in the esophagus and stomach area. Sterile washing and draping. Creation of an apron flap. However, this is only prepared up to the level of the hyoid bone in order to keep the neck opening as small as possible. Exposure of the cervical vascular sheath. This is very difficult on both sides as the patient has been pre-operated and pre-irradiated. The entire tissue is fibrotically altered and massively scarred. Skeletonization of the larynx with separation of the infrahyal musculature. Exposure of the hyoid bone. Detachment of the thyroid gland on both sides. Release of the piriform sinus on the left side. This cannot be done on the right side due to the tumor. Entering the pharynx on the right side. Disluxation of the epiglottis and inspection of the tumor region. The tumor appears as described above, starting at the tonsil lobe on the right side and extending caudally. First, release the laryngeal region from the pharynx on the right side. Cut around the tumor region with a safety margin of at least 1.5 cm. The tumor extends to the esophageal entrance and can be placed there together with the laryngeal preparation. The specimen is thread-marked and sent for frozen section. The frozen section still shows parts of carcinoma in situ at the entrance to the oesophagus. A large resection specimen is taken here and another marginal specimen is taken for frozen section. Final R0 situation. Lifting the radial artery graft from the left. The radialis graft is 15x9 cm in size, as almost the entire pharynx has to be reconstructed. Only a narrow strip remained. Marking of the graft. Incision around the skin island and extension of the incision on the forearm. Depiction of the brachialis muscle. Exposure of the cephalic vein and other superficial veins. Exposure of the venous star in the crook of the elbow with exploration of the venous confluence between the superficial and deep venous system. Finding the superficial ramus of the radial nerve. This is divided into three branches. All three branches can be dissected and pushed laterally so that they do not have to be integrated into the graft. Locating the radial artery. Ligation and removal of the radial artery. Exposure of the tendons. Lifting the graft from the tendons. It is clear that the radial artery is massively calcified and looks like a rigid calcareous tube in large parts. Despite this, the graft is well perfused throughout the entire preparation time and the hand is also monitored by pulse oximetry and is also completely perfused with over 90% oxygen saturation. The stem is prepared in the usual way. The graft is placed in the crook of the elbow so that two veins are present. One from the superficial system and one from the deep system. The graft is sutured into the pharynx, starting in the tonsil lobe, down to the esophageal entrance. The esophageal entrance is reconstructed using a pointed Z-plasty. This is achieved by advancing the sutures. A Provox prosthesis was previously inserted in the usual way using the pull-through method. The oesophagus is easily passable digitally, so that a myotomy is not necessary. Perform a myotomy in the area of the sternocleidomastoid on both sides. The superior thyroid artery is used for the anastomosis of the radial artery graft for the venous limb. This works without any problems. Use of a coupler for the venous anastomosis, once to the superior thyroid vein and once to a more caudal outlet vessel from the internal jugular vein. Reconstruction of the tracheostoma. Insertion of a flap on the anastomosis side and insertion of a Redon drainage on the opposite side. Two-layer wound closure. Insertion of a tracheostomy tube, suturing of a tracheostomy tube. Completion of the procedure without complications. A nasogastric tube was placed intraoperatively. Please take X-ray and swallow on the 12th postoperative day and, if necessary, build up a diet, antibiotics for 24 hours.