First deepening of the anesthesia, bronchoscopic intubation (very difficult) through the anesthesia. Nasotracheal intubation is finally successful. Head positioning, insertion of the mouth guard. Insertion of the size C and D small bore tube. The tumor begins in the lower part of the oropharynx on the left, then moves caudally along the hypopharyngeal side wall, leaving out the esophageal mouth, but does not reach the midline of the hypopharynx. However, the vallecula is included, but does not extend to the midline. The epiglottis is also affected on the laryngeal side. After inspection, repositioning, skin disinfection and infiltration anesthesia with 15 ml Ultracaine with added adrenaline cervically on both sides. Then skin disinfection. After head positioning, formation of an apron flap. Preparation subplatysmal. Release of the submandibular glands on both sides. Protection of the infrahyoid musculature. Start with neck dissection on the left side: a cN2b status is seen here, infiltration in the sternocleidomastoid muscle and the internal jugular vein. First dissection along the muscle, which is then cut caudally and the internal jugular vein and the common carotid artery as well as the vagus nerve are identified on the vascular nerve cord. Dissection cranially. Then first release the medial neck preparation ventrally. Dissection of the infrahyoid musculature up to the digastric muscle cranially, then from the muscle belly dissection dorsally. Definition of the posterior border. Then consecutive release of the metastasis-neck preparation from medial to lateral. Ligation and ligation of the macroscopically visible infiltration of the internal jugular vein. Protection of the internal, common and external carotid arteries and the vagus nerve. Once the hypoglossal nerve has been identified, it is also safely mobilized from the tumour conglomerate under macroscopic vision in healthy tissue and dissected. Removal of the entire tumor preparation and removal of most parts of the cervical plexus and the accessorius nerve. After careful hemostasis, placement of a Redon drain. Now transfer to the right side: first mobilize the sternocleidomastoid muscle here as well. No macroscopically conspicuous lymph nodes here. Then develop the lateral neck preparation from caudal to cranial. Identification, visualization and protection of the accessorius nerve. Evacuation of the accessorius triangle and levels II, III, IV and V. In the end, no evidence of lymph flow or bleeding. Skeletonization of the laryngeal skeleton between the upper edge of the thyroid cartilage and the hyoid. Incision on the edge of the thyroid cartilage. Dissection and mobilization of the constrictor and hypopharyngeal mucosa ventrally. Entering the lumen in the area of the base of the tongue. Inspection with an overview of the tumor. The tumor is now removed macroscopically under visualization, the larynx is then developed consecutively from cranial to caudal under visualization. The entire tumor preparation is then suture-marked and sent for frozen section diagnostics, which also revealed tumor extensions in the area of the right-sided margin. At this point, a resection was also sent, but it was tumor-free, so that after taking a new strip until the final histology, it can be assumed that an in sano resection margin of 1.0 to 1.5 cm was maintained. After hemostasis, the tracheotomy was performed: fixation with 2 holding sutures. Then, after myotomy of the cricopharyngeus, placement of a Provox 2 prosthesis in the usual manner and beginning with the single-button suture of the pharyngeal mucosa, which is guided inverted from caudal to cranial. In the tongue base area, T-shaped adaptation of the tongue base resection margin with the mucosa of the pharynx. Two-layer wound closure possible here without tension. Intraoperative demonstration of findings on <CLINICIAN_NAME>. Mobilization of the infrahyoid musculature, which is now mobilized cranially, which is very successful and is stitched together with the thyroid gland as a stable muscle cuff over the pharyngeal suture, so that the entire suture area can be covered in the neopharyngeal region. Suturing of the tracheostoma with Ethibond sutures, two-layer wound closure after ensuring the correct position of the Redon drainage on both sides and application of a sterile dressing. Stable ventilation conditions under the inserted 10 mm tracheostomy tube. The patient received perioperative antibiotics with clindamycin 600 mg, which should be continued perioperatively. Due to the parabasal position of a peripheral venous catheter in the left arm, this should be monitored in the further postoperative course. Blood-free conditions at the end of the procedure. Removal of the gastric tube after swallowing gruel on postoperative day 7. A gastric tube was not placed with the PEG tube in place.