First, oral cavity inspection again. Pharyngoscopy and laryngoscopy: The relatively inconspicuous and flat tumor is seen in the area of the tonsil lobe, which is also somewhat hardened. No growth in the tonsillar lobe. Tumor also well mobile. Indication for surgery therefore given. PEG insertion: insertion of the flexible esophagoscope, after creation of the diaphanoscopy insertion of a 15 mm abdominal wall tube without complications. Fixation to the abdominal wall in the typical manner. Now first insertion of the Mc Ivor blade. The tumor is incised with a safety margin of at least 1 cm on all sides, also in depth. The anterior palatal arch, the tonsil and parts of the base of the tongue and the glossotonsillar groove are removed. The posterior palatal arch remains almost intact. The specimen is removed, thread-marked and sent for frozen section. Tumor-free on all sides in the frozen section. Thus R0 situation with regard to the primary tumor. Careful hemostasis. Now repositioning for neck dissection on both sides and tracheotomy. Beginning with neck dissection on the right: skin incision in typical manner. Exposure of the sternocleidomastoid muscle. The mass is located cranially and is relatively difficult to move. Infiltration into the soft tissue is to be expected here. As the dissection progresses, it becomes apparent that the mass is growing up to the lower tonsil pole, which is also resected. Also infiltration of the sternocleidomastoid muscle, the internal jugular vein and parts of the branches of the cervical plexus. First presentation of the omohyoid muscle and digastric muscle. The latter must be resected laterally as it is infiltrated. Visualization of the internal jugular vein. It can be visualized caudally, cranially it is clearly infiltrated by the tumor. Depiction of the internal and external carotid artery. The external artery is infiltrated at its outlets. The branches are successively dissected and ligated. The course of the external artery can be preserved up to the parotid gland. The superficial temporal vein is ligated. The facial vein is also ligated. In the area of the bulb and the internal carotid artery, the lymph node conglomerate lies close to these structures. Difficult dissection of the internal carotid artery, which is exposed up to the base of the skull in order to dissect the tumor. However, this is completely successful. No evidence of real infiltration of the wall. Clear tumor infiltration in the area of the hypoglossus, which is also resected. The vagus nerve is also located in the tumor conglomerate and is also thickened. Therefore co-resection. Also resection of the accessorius nerve. Upper parts of the cervical plexus branches must also be partially resected. The phrenic nerve can be preserved, as can the lower parts which extend supraclavicularly. In addition to the large lymph node conglomerate, there are multiple other lymph nodes between the branches of the cervical plexus. A resection up to level Vb and level IIb followed, with complete removal of levels II to V. In the course of the procedure, the caudal parotid pole was resected to confirm a resection in healthy tissue. This also included visualization of the oral branch, which can be preserved. Also marginal samples from the cranial accessorius and vagus area. These marginal samples are healthy. Overall, however, in addition to the large lymph node metastasis conglomerate with clear soft tissue infiltration, multiple metastases level II, III, IV, V. Careful hemostasis, irrigation with hydrogen and Ringer's solution. Wound closure in layers with insertion of a Redon drain. Due to the extensive metastasis in the neck region on the right, neck dissection on the left is now indicated. Tracheotomy also indicated due to the extensive resection of the important structures on the right side of the neck. Left neck dissection and tracheotomy (<CLINICIAN_NAME>, <CLINICIAN_NAME>). Marking of the planned skin incision on the left, curving from mastoid to caudal along the anterior edge of the sternocleidomastoid. Marking of mandibular angle and mandibular branch. Skin incision using a scalpel through the subcutaneous tissue and platysma. Separation of the platysma. Development of a skin flap by successive dissection along the platysma. Exposure of the sternocleidomastoid anterior margin. Exposure of the internal jugular vein, the accessorius nerve. Exposure and dissection of the omohyoid muscle, the submandibular gland and the anterior posterior digastric venter. Exposure of the hypoglossal nerve. Exposure of the ansa, free preparation of the internal jugular vein and the facial vein as well as other outlets to obtain venous drainage. Development of the medial neck preparation and resection of the same. The superior thyroid artery cannot be spared here; it is ligated and clipped. Now dissect the lateral neck specimen. To do this, expose the common carotid artery and the vagus. Dissection from caudal to cranial, taking level V to Ib. The ansa is visualized as well as the plexus, which is spared. No evidence of hilar fistula. Removal of the neck preparation. Hemostasis, irrigation with H202 and Ringer. Insertion of a 10-gauge Redon. Two-layer wound closure. Subsequent tracheotomy. For this purpose, marking of the skin incision 1 QF below the cricoid cartilage, skin incision of approx. 3 cm, dissection through cutaneous and subcutaneous tissue, ligation of larger caliber veins. Exposure of the linea alba and pushing the infrahyoid muscles to the side. Dissection on the cricoid cartilage. Exposure of the anterior surface of the trachea. Exposure of the narrow glandular isthmus, which is undermined and extensively bipolarized. Truncus brachiocephalicus is not palpable. Now create a Björk flap between the 2nd and 3rd tracheal clasp, this is successful without any problems. Suturing of the same using a total of 5 stoma sutures. Insertion of an 8 mm cannula and problem-free reintubation. Re-inspection of the right neck, here again bipolar coagulation. Irrigation with H202. Insertion of a 10-gauge Redon and two-layer wound closure. Finally, cT1-2 tonsillar carcinoma removed in healthy tissue. Extensive neck metastasis on the right with multiple metastases under a very large metastatic conglomerate. Postoperatively, the patient is admitted to the intensive care unit for one night for monitoring. Please continue antibiotics started intraoperatively. Plan further procedure after receiving the final histology. RCT is most likely indicated.