Induction of anesthesia and intubation by the anesthesia colleagues. Sterile washing and draping. Creation of an apron flap and start of neck dissection on the right side. The skin over the metastases is dissected off for this purpose; the platysma cannot be spared in part as it is adherent to the metastases. Exposure of the sternocleidomastoid muscle in the caudal region. Separation of the sternocleidomastoid muscle. Exposure of the internal jugular vein. Dissection of the large metastases from the internal jugular vein in the caudal region. Then removal of the omohyoid muscle. Dissection of the common carotid artery. Dissection of the division into external and internal carotid artery. Both divisions can be preserved, but the facial artery runs directly into the tumor. The superior thyroid artery also enters the tumor. The hypoglossal nerve and the accessory nerve extend into this metastatic tumor, as do the plexus branches, all of which are completely resected. The submandibular gland is partially resected. The neck conglomerate is sent for final histology with suture marking. Level II b is then removed and sent for histology. Neck dissection on the left side is performed by <CLINICIAN_NAME>. After subplatysmal dissection of the apron flap up to the submandibular gland, the neck is dissected on the left side. Open the capsule of the submandibular gland and dissect in depth to expose the digastric muscle. Exposure of the accessorius nerve and exposure of the nerve. This can be completely preserved. Dissection of the neck specimen along the anterior venter of the digastric muscle and detachment of the specimen up to the hyoid bone. Exposure of the facial vein. Identification of the hypoglossal nerve. The facial vein can be preserved. Sharp dissection on the vein and lateral striking of the neck preparation. The vein can be completely detached from the neck specimen by inserting a .............................. The common carotid artery and vagus nerve are exposed. The neck preparation is now detached from the deep cervical fascia from cranial to caudal. Particular care is taken to spare the deep branches of the cervical plexus. The accessorius nerve is also not injured. After releasing the neck preparation, inspect the wound area. After hemostasis with the bipolar coagulation forceps, there is no further bleeding. After removal of the neck specimen at the level of the junction of the omohyoid muscle and the internal jugular vein, there is no evidence of a chyle fistula. Exposure of the outlets of the external carotid artery (the superior thyroid artery and the facial artery can be safely exposed and dissected). Completion of the neck dissection on the left side without complications. Now release of the larynx by <CLINICIAN_NAME>. Skeletonization of the hyoid bone. Removal of the hyoid bone. Release of the piriform sinus. Neck level VI was removed beforehand. Then entering the pharynx from the left side. It can be seen that the tumor grows very far into the base of the tongue. Tumor resection with a safety margin of 1 ˝ cm. Cut down towards the postcricoid region, first on the left side, then on the right side. Some of the pharynx must also be resected on the right side. Then place the larynx below the cricoid cartilage and send the specimen marked with a suture for frozen section. All frozen sections are designated as R0, but at one point with a safety margin of just under 0.2 cm. A resection of the pharyngeal mucosa on the left side is taken, which is then also designated as R0. Now insertion of a Provox Vega prosthesis size 10 in the usual manner. Mobilization of the base of the tongue and the pharynx in the cranial region. Pharyngeal suture in the usual manner in two layers. A T-shaped suture must be applied in the area of the base of the tongue, as otherwise there is too much tension due to the relatively large amount of mucosa missing here. However, due to the overall situation of the patient and the still sufficient mucosa for a primary closure, the decision is made against a free graft or a pedicled graft. Finally, a mucocutaneous anastomosis is created at the tracheostoma. Insertion of Redon drains. Two-layer wound closure and completion of the procedure without complications. The patient is ventilated and admitted to the intensive care unit. Please continue antibiotics for at least 24 hours. X-ray gruel swallow in this case only after the 14th postoperative day.