Thirty-four patients underwent tracheal sleeve pneumonectomy during the years 1964 through 1981. In 30 patients, simultaneous resection of the right lung and carina was performed with an anastomosis established between the left main bronchus and trachea. In four patients a previous pneumonectomy had been performed (two right and two left) and, because of recurrence in the stump, resection of the stump and carina was carried out with either right or left bronchotracheal anastomosis. Preoperative irradiation was given in 28 of the patients in the group, and tumor sterilization occurred in six of those so treated. Four of 30 patients are long-term survivors: Two are still alive and free of cancer at 7 and more than 11 years postoperatively. One patient in the group of four with stump recurrence is alive more than 11 years postoperatively. All long-term survivors had epidermoid carcinoma and all received preoperative irradiation. The most frequent complications were fistula formation and pneumonia, resulting in 10 deaths in the perioperative period for a mortality of 29%. The 5 year survival rate of the entire group was 15%, and the survival rate by life-table analysis in the 30 patients with lung and carinal resection was 13.3% at 5 and 8.8% at 10 years.