Most of the benign tracheal stenoses encountered in clinical practice nowadays are complications of tracheal intubation or tracheotomy during resuscitation of serious diseases, and a few are traumatic injuries and benign tracheal tumors. Malignant tracheal tumors, on the one hand, show malignant features and can invade surrounding organs and can metastasize locally or systemically, but their most important pathology is to develop into the tracheal lumen and cause severe tracheal stenosis, and most patients with malignant tracheal tumors still die from tracheal stenosis respiratory failure. Therefore, once tracheal tumor patients are detected, the main and most urgent treatment is still to address the tracheal stenosis. The best treatment for tracheal stenosis and tumors should be said to be surgical resection. Only the simplest and relatively small lesions or tumors are suitable for treatment such as endoscopic laser or cryotherapy. Of course, cases that are inoperable or refuse surgery can be treated endoscopically. Most tracheal tumors, including of course benign tracheal stenosis such as scar stenosis, are poorly treated with radiation and even less effectively with chemotherapy. Therefore, it can be said that surgery is the best treatment for tracheal stenosis and tracheal tumors. It is only because the surgery for tracheal resection is technically difficult and risky, therefore, the hospitals and doctors who accept it are quite rare. The best option for surgical treatment of tracheal stenosis and tracheal tumors should be segmental trachelectomy. Partial partial resection is generally not advocated. It is an emergency procedure as a last resort, unless technical skills are not available and the patient is at risk of death by asphyxia. Otherwise, segmental trachelectomy should be performed. Because the defect in the tracheal wall needs to be repaired after local excision, the repaired tissue needs to be tipped and needs to have a blood supply. If direct suturing is done, there will be more tension, which will affect the healing, and in severe cases, cracking, infection or even death. Moreover, the trachea will be folded and deformed after direct suturing. Only after segmental resection, it is most consistent with normal anatomy and physiology. Segmental trachelectomy requires close multidisciplinary cooperation. Preoperatively, radiology X-ray chest film, CT or MRI examination, two-dimensional reconstruction, simulated tracheoscopy requires respiratory medicine bronchoscopy to further accurately determine the extent, nature of the lesion; cardiology to assess whether the heart function is normal and whether it can accept general anesthesia for major surgery, including open-heart surgery; liver and kidney function must also be able to withstand the surgical blow; most importantly, anesthesiology needs to have a considerable level of ability to cope with various preoperative Most importantly, the anesthesiology department needs to be able to cope with all kinds of difficult problems related to ventilation and anesthesia that may arise before, during and after surgery. Usually, general anesthesia with tracheal intubation is required. However, tracheal scarring or tumors have narrowed the trachea so much that breathing without intubation is significantly more difficult. Tracheal intubation requires induction of anesthesia, complete muscle relaxation, and cessation of spontaneous breathing, and the narrowing of the trachea adds more technical difficulties to the intubation, making successful intubation unpredictable and even confusing, making it difficult for the surgeon to work easily and comfortably as usual. If intubation fails, the patient is always at risk of suffocation. If the surgery is performed by extracorporeal circulation, the safety of anesthesia is improved, but the patient is at increased risk of extracorporeal circulation, which itself has a certain mortality rate. Moreover, the cost, operating time, and the risk of intraoperative and postoperative bleeding are all greatly increased. All are greatly increased. Most patients require transoral tracheal intubation prior to tracheotomy, and after tracheotomy, all require distal tracheal intubation via the operating table to maintain anesthesia and ventilation. Open-heart surgery often also requires single-lung ventilation with a double-lumen tracheal tube. Ventilation problems can occur with slight inattention during surgical operations, and serious accidents such as cardiac arrest can occur. The close cooperation between the surgeon and the anesthesiologist is an important guarantee for the success of the operation. And this tacit understanding is often not achieved in every hospital, and this tacit understanding is not achieved by every surgeon. In today’s tense doctor-patient relationship, medical marketization, and everyone’s personal interest social environment, the close and intimate cooperation of all departments is something that is even more difficult to achieve in many hospitals. But this is a major guarantee of successful tracheal surgery! Surgery is of course the main key. The specific location and size of the disease determines the surgical approach. The simple ones can be operated via the neck, some need to be operated via the open chest, some need a median open chest, some need a conventional posterior lateral incision to open the chest, some can have an anterior lateral incision to open the chest, and some need a combination of a neck incision and an open chest incision. Pre-operative preparation needs to be extraordinarily thorough, taking into account all the unexpected possibilities and preparing for what to do in case of over-expectation, whether there are alternatives, and whether there are means to ensure invincibility. What if there is a difficult anastomosis? What should be the last step? In short, the more detailed the preoperative thinking, the smoother the intraoperative process will be. The greatest difficulty in segmental tracheal resection is not the resection itself, but the ability to safely and tension-free anastomosis is the key. And once more than 1/3 of the trachea is removed, it is impossible to achieve a tension-free anastomosis! It is all about tension anastomosis. The biggest disaster is a failure to anastomose. No matter what release you use, the two severed ends of the trachea will still not achieve a safe anastomosis.