1. Indications - Postintubation lesions: the most common indication for tracheal resection and reconstruction - Malignancies, including predominantly squamous cell carcinoma and adenocystic carcinoma - Secondary tracheal tumors, tracheoesophageal, and tracheal innominate fisutlas 2. Contraindications - Medical contraindications to such extensive surgery - A careful evaluation of pulmonary function, if lung resection is to be included. - For a right carinal pneumonectomy (the most common carinal resection), the distance from the right distal tracheal margin to the proximal medial left mainstem should not exceed 4 cm in most cases. - Prior irradiation is a relative contraindication - Tracheal resection of over half the trachea 3. Anesthesia - General anesthesia with an arterial line and often central line - Airway control is critical for tracheal resections. - Ventilation while resecting the stenosis can be maintained via an endotracheal tube passed into the operative field. Additional options include JET ventilation or hyperventilation with periods of apnea. Rarely, extracorporeal membrane oxygenation (ECMO with cardiopulmonary bypass) needs to be established prior to or during intubation. - Most patients are extubated in the operating room and monitored in the intensive care unit postoperatively. 4. Equipment - Operative table - Thoracotomy tray - Multiple sizes of endotracheal tubes - Ability to perform JET ventilation - Ability to place on ECMO - Rigid bronchoscope with dilators and laser for possible dilation prior to resection - Bean bag, pillows, and cushions to allow for positioning 5. Technique - Cervical tracheal resection and intrathoracic tracheal resection via sternotomy - Intrathoracic tracheal resection and right tracheal sleeve pneumonectomy via right thoracotomy approach 6. Complications - Bleeding - Infection - Airway edema - Pulmonary insufficiency - Anastomotic dehiscence - Anastomotic fistula - Tumor recurrence - Anastomotic stenosis - Anastomotic leak