Resection and reconstruction of the central airways is a multidisciplinary team effort involving thoracic surgeons, pulmonologists, anesthesiologists, radiologists, and nursing staff, which should be performed in a tertiary reference center for thoracic surgery. Anatomic knowledge, particularly of the blood supply of the trachea, carina, and main stem bronchi, is crucial. Technical mastery of various surgical approaches, anastomosis techniques, muscle flaps, and tracheal/bronchial release maneuvers to mobilize the trachea are a basic prerequisite for successful resection and reconstruction of the central airways. Up to two-thirds (approximately 6 cm) of the trachea can be resected and primarily anastomosed. The main aim of any resection of the central airways is a tension-free, well-vascularized anastomosis.