Carinal resection is considered the most complex procedure in general thoracic surgery, because of the complexity of the surgical reconstruction, anesthetic and postoperative management, and the potential for lethal morbidity and mortality. Long-term survival of malignancies involving the carina is mainly affected by lymph node status, for which mediastinal staging is of paramount importance in selecting patients and should include 2-deoxy-2-[¹⁸F] fluoro-d-glucose positron emission tomography, endobronchial ultrasound-guided fine-needle aspiration and biopsy, and mediastinoscopy. Surgical approaches and reconstruction techniques vary according to the extent of disease and the cause of the lesion (benign vs malignant).