Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases.