Carcinoma of the lung can involve the carina. Resection then encompasses resection of the lung with the carina. Success of this complex procedure is based on careful selection of patients, judicious use of multimodality therapies, and expert multidisciplinary care. Selection of patients is based on staging of the cancer and an evaluation of their cardiopulmonary reserve. The surgery must aim at removing all of the malignancy and nodes. The anastomosis must be tension free and buttressed with a vascularized pedicled flap. Multiple ways are available to maintain proper ventilation of patients during the reconstruction of the carina.