The carinal resection is still considered a real challenge, both for a thoracic surgeon and an anesthesiologist. Depending on the indications and the degree of local advancement of the neoplasm, there are 2 techniques of carinal resection and reconstruction. The first one consists of the isolated resection with formation of a new bifurcation, whereas the second one is a combination of anatomic resection of lung parenchyma together with the bifurcation and the subsequent reconstruction. Long-term outcomes after carinal resection procedures, with clear postoperative margins, depend to a large extent on the stage of advancement of the primary disease.