PEG insertion (<CLINICIAN_NAME>): Placement of the PEG tube after flexible gastroesophagoscopy and performance of positive diaphanoscopy in the usual manner using the thread pull-through method. Removal of the left radial lobe (<CLINICIAN_NAME>): Palpatory identification of the distal radial artery. Marking of the flap borders 9x7 cm on the distal forearm proximal to the retinaculum floxorom with an S-shaped incision running proximally into the cubital fossa. Cutaneous and subcutaneous incision starting proximally, identification and visualization of the venous confluence in the cubital fossa. The cephalic vein is well developed on this side. There are now already 2 large veins to the anastomosis in the cubital fossa. Now identify the external ramus of the radial nerve and leave the peritendineum of the tendon of the brachioradialis muscle and incise down to the forearm fascia, incise the fascia and then lift the flap fascially to the end of the flexor carpi radialis muscle. Care is taken to leave the peritendineum on the flexor tendon and to spare the ulnar artery. The ulnar artery is spared, the radial artery is identified distally, palpated and clamped. Clamping of the vessels with the HDS clamp, after 5 minutes under good oxygen saturation measured by pulse oximetry on the palate, the vessels are removed with subsequent Ethibond 0 ligation. The successive detachment of the flap pedicle from the flexor pollicis longus muscle was performed. Larger perforators were treated with clips. The ulnar, brachial and radial arteries are identified proximally. The flap is then placed on the radial artery and 2 large veins in the cubital fossa are also placed, which are suitable for anastomosis. The flap is irrigated with heparin. Regular situation. The flap is now transferred for suturing and the arm is closed proximally in 2 layers with 4-0 Vicryl and 5-0 Ethilon. Distally, the resulting defect is sutured using split skin with 5-0 Ethilon. The previously fitted forearm splint is then applied and flap elevation is completed without complications. Tumor resection by <CLINICIAN_NAME> and <CLINICIAN_NAME>: Insertion of the McIvor oral retractor with the small spatula and adjustment of the site. This shows a coarse, ulcerated mass localized to the left tonsil lobe. Submucosally, the mass extends just above the cranial tonsil pole. The resection margins are determined in the presence of <CLINICIAN_NAME>. Successive tumour resection after mobilization of the upper tumour pole under constant palpatory control. The resection is performed in healthy muscle tissue. Lateral parapharyngeal fat is visualized. Bleeding is stopped with the bipolar coagulation forceps. After cutting around the caudal pole of the tonsil, leaving a strip of the base of the tongue on the tumor resectate, the sutures are marked on all 4 quadrants. The resectate is sent in its entirety on cork for a frozen section histopathological examination. After 1 hour, the feedback is received that the tumor has been resected R0. All tumor margins are free. Subtle hemostasis in the tumor bed using bipolar coagulation forceps. Neck dissection is performed on the left side by <CLINICIAN_NAME>: After infiltration with local anesthetic containing adrenaline, the corresponding arcuate skin incision is made. Sharp dissection through the cutis and subcutis with exposure of the sternocleidomastoid muscle. The large, easily displaceable metastasis is located immediately adjacent to this. This is first exposed on all sides, whereby the neck dissection specimen is successively dissected along the omohyoid muscle, digastric muscle with parts of the caudal parotid gland and the sternocleidomastoid muscle. Open the vascular nerve sheath caudally and dissect cranially. Expose the internal jugular vein and the common carotid artery as well as the vagus nerve in between, which can be spared until the end. Subsequently, successive cranial dissection with successive detachment of the large metastasis from the internal jugular vein, which is ultimately also successful in a healthy layer. The digastric muscle is followed ventrally from its anterior belly via its tendon to the posterior belly and the specimen is thus also dissected laterally. The hypoglossal nerve is preserved. Finally, the metastasis with the caudal parts of the parotid gland is completely detached from the vascular nerve sheath. The accessory nerve can also be preserved intact from region II. The neck dissection is then completed with resection of regions II to V so that the neck dissection specimen can be resected en bloc together with the large metastasis. The submandibular gland is then removed and region I cleared. In addition to the lingual nerve, the enoral defect that will later be used for the flap can also be seen here. Neck dissection on the right by <CLINICIAN_NAME> and PJ: Skin incision on the anterior edge of the sternocleidomastoid muscle. Separation of the cutaneous and subcutaneous tissue. Exposure of the platysma and transection of the platysma. Snaring of the platysma and subplatysmal flap preparation. Ligation of the external jugular vein. Exposure of the auricular nerve and protection of the nerve. Now dissection in depth along the anterior edge of the sternocleidomastoid muscle. Expose the posterior digastric venter muscle and the omohyoid muscle. Insertion of blunt retractors and exposure of the cervical vascular nerve sheath. This is successively freed from the neck preparation. Now remove the neck preparation after visualization and release of the accessorius nerve from cranial to caudal, taking level II a, II b, III, IV and V. Insertion of a 10 Redon drain. Subtle hemostasis using bipolar coagulation forceps. Irrigation with hydrogen and Ringer and two-layer wound closure on the right side of the neck. Now the radialis graft is inserted by <CLINICIAN_NAME>: looping the cranial flap end cervically with a clamp and pulling through the opening. Insertion of the graft into the tumor resection box. Flap fixation and suturing of the flap in single button sutures in the usual manner without complications. Inspection shows good closure with a well-fitting graft. Anastomoses through <CLINICIAN_NAME>: After appropriate suturing of the flap enorally, the stalk is passed outwards and fixed with 2 retaining sutures. The arterial anastomosis is made to the superior thyroid artery on the left side. Venous drainage is then ensured by the two existing veins, which are connected to the internal jugular vein in an end-to-side manner. The tracheotomy is then created by <CLINICIAN_NAME>: horizontal skin incision just below the cricoid over 2 cm. Separation of the cutaneous and subcutaneous tissue. Dissection into the fatty tissue and exposure of the infralaryngeal musculature, which is split in the middle and the thyroid isthmus is exposed. Undermining of the thyroid isthmus. Bipolar coagulation and transection with the scissors. Identification of the anterior tracheal wall and entry into the 2nd and 3rd intertracheal ring space. Incision of the tracheostoma in the usual manner using epithelializing single-button sutures. Insertion of a 9 mm tracheostomy tube and completion of the tracheostomy without complications.