Surgical considerations in tracheal and carinal resection.

Surgical resection of the trachea and carina requires a highly specialized team of thoracic surgeons, anesthesiologists, and operative support staff because of the complex nature of these procedures. Improvements in the design and application of low-pressure cuffed endotracheal tubes and extensive experience in tracheal reconstruction have reduced ventilation associated airway injury and facilitated new techniques for repair. Even with these improvements, tracheal surgery for stenosis is still commonplace, as is the need for resection in cases of benign and malignant lesions of the airway. Surgical consideration of malignant lesions involving the carina remains a challenge for localized cancer and more commonly for tumors arising from the lung with radial involvement of the main bronchus and carina. These patients often require pneumonectomy during carinal resection with complicated reconstructive efforts to establish airway continuity. Careful patient selection, operative planning, and execution by both the thoracic surgery and anesthesia teams are required for optimal results.