Carinal resection is defined as the resection of tracheo-bronchial bifurcation, with or without lung parenchyma resection. It represents one of the most challenging areas of airway resection and reconstruction, basically due to the variability in the location and extent of the lesions. Main indications for this procedure are primary tumours of the carina or the distal trachea or, more frequently, bronchogenic carcinoma with carinal involvement. Very different approaches and reconstruction techniques have been experimentally and clinically described in the last 50 years, with some corner stone procedures in the history of modern thoracic surgery. Despite many technical and oncological difficulties encountered in this field, encouraging results have been reported in recent series, in particular an excellent 5-year survival rate of 50% in pN0 patients suffering form carinal infiltration form lung cancer. Several aspects of the multimodality approach to neoplastic carinal involvement still remain debatable like radio-chemotherapeutic approach instead of the extremely rare left carinal pneumonectomy as well as the role of induction treatments before embarking in such demanding procedures, according to the -pathological nodal status.