After induction and intubation by the anesthesia colleagues, the patient is first positioned. Repeat pharyngo-/laryngoscopy: For this purpose, enter with the Kleinsasser tube under dental protection. With an unremarkable oral cavity and oropharynx as well as an unremarkable endolarynx, the exophytic tumor can be seen in the right-sided postcricoid region, as described above, measuring approx. 2 cm and still well mobile at the mucosal level without submucosal infiltration of the thyroid cartilage or the arytenoid joints. The rest of the hypopharynx is free up to the tips of the piriform sinus and the esophageal opening. The dental guard, the lip retractor and the FK blocker are now inserted. Difficult, but ultimately regular adjustability of the tumor with good exposure of the postcricoid region. Successive resection of the tumor with the monopolar. Resection while sparing the cartilaginous bony structure. The tumor is sent for definitive histology. Removal of representative marginal samples. These are shown to be completely tumor-free in the frozen section diagnostics. Therefore, after careful wound inspection and hemostasis, a nasogastric feeding tube is initially inserted if the endolaryngeal conditions are narrow and a tracheotomy is not performed if the conditions are narrow. Rearrangement for neck dissection: palpation reveals a rough and barely displaceable paralaryngeal mass. Injection of xylocaine with adrenaline. Incision of the old scar. Cutting of skin and subcutaneous tissue. Subcutaneous extensive scarring. Cutting through the remains of the platysma. Exposure of the sternocleidomastoid muscle. This is broadly infiltrated from the underside, therefore first exposing the submandibular gland and the digastric muscle. Exposure of the omohyoid muscle caudally. Separation of the sternocleidomastoid muscle and preservation of the external jugular vein. The omohyoid muscle is also clearly infiltrated. The same applies to the parlaryngeal musculature. The cranial accessorius nerve can be preserved. Thorough exposure of the internal jugular vein. The facial vein is infiltrated, otherwise the internal jugular vein can be preserved. Careful dissection of the common carotid artery. The mass extends directly to the perivascular connective tissue, but is certainly not infiltrated. Dissection in case of infiltration of the superior thyroid artery. There is also clear infiltration of the hypoglossal nerve. This is also removed. Dissection of the cervical vascular sheath, which is normal except for the infiltration of the structures mentioned. Clearing of the accessorius triangle while preserving the nerve. Clearing of level V with careful preservation of the cervical plexus branches. Overall en bloc resection of the massively surrounding scarred and massively perinodally growing metastasis. Careful wound inspection. Wound irrigation. Insertion of a 10-gauge Redon drain and careful two-layer wound closure. Turning to the opposite side: skin incision also made on the anterior edge of the sternocleidomastoid muscle. Cut through the skin and subcutaneous tissue. Exposure and transection of the platysma. Creation of a platysma flap. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland and the digastric muscle. Removal of the anterior neck preparation with careful protection of the superior thyroid artery, the facial vein and the cervical vein. Free preparation of the internal jugular vein. Exposure of the accessorius nerve. Clearing of the accessorius triangle and clearing of level V a with careful protection of the cervical plexus branches. Careful wound inspection and, if the wound is dry, wound irrigation, insertion of a 10 Redon drain and careful two-layer wound closure. Subsequent completion of the procedure with slim enoral conditions. The patient received intraoperative single-shot antibiotics with Unacid. Postoperative nutrition via the inserted nasogastric tube for 3 to 4 days, after which oral nutrition should be possible without any problems. Presentation in our interdisciplinary tumor conference and in the meantime planning of a new esophagogastroscopy with endosonography as already indicated by our colleagues in internal medicine.