Sleeve pneumonectomy remains a surgical challenge with specific problems of intraoperative surgical and anesthesiologic management. In the present chapter we expose the techniques currently employed in our institution. Sleeve pneumonectomy is associated with a non-negligible mortality, with figures ranging from 8% to 15%. This operation is able to provide microscopic free margins (R0) for the majority of the patients, which is an important prognostic factor. Results in terms of long-term survival are encouraging as overall 5-year survival rates range from 25% to 45%, which is to be considered as a satisfactory result for these patients with a locally advanced cancer. Nodal status is a relevant prognostic factor as patients with N2 disease have survival rates lower than 15%.