Carinal and Tracheal Sleeve Resection and Reconstruction for Oncological Disease: A Narrative Review with Single-Centre Clinical Experience

Carinal and tracheal sleeve resections represent the most technically demanding procedures in thoracic surgery, reserved for a highly selected subset of patients with primary tracheal tumours or bronchogenic carcinomas involving the tracheobronchial angle. Despite advances in anaesthetic management and surgical technique, these operations carry substantial perioperative risk; reported mortality rates range from 3% to 20% even in high-volume centres. This narrative review appraises current evidence on tracheal and carinal resection for oncological disease, focusing on surgical technique, anaesthetic strategies, including the expanding role of veno-venous extracorporeal membrane oxygenation (VV-ECMO), and oncological outcomes, and positions these findings against several closely related reviews published in 2025–2026. The principles of tracheal surgery are reviewed: tension-free anastomosis, preservation of segmental blood supply, and suture technique. We also present our institutional experience with complex carinal resections, including three left tracheal sleeve pneumonectomies performed through median sternotomy without cardiopulmonary bypass and other cases of major tracheobronchial surgery. Our institutional experience illustrates that, in expert hands, these operations can offer favourable long-term survival, particularly for adenoid cystic carcinoma and for patients with N0–N1 disease. VV-ECMO and apnoeic oxygenation may facilitate resections that would otherwise be technically prohibitive and have shown encouraging safety in selected expert-centre series, although this evidence remains limited to small, non-comparative cohorts.