Throughout the last year significant advances in the operative technique and management of patients undergoing sleeve pneumonectomy, as well as better understanding of patient selection requirements, have led to improved perioperative and long-term results. Patients with N2 disease resistant to preoperative chemotherapy or chemo-/radiotherapy should be excluded from the procedure. Airway resection should be limited to a maximum length of 4 cm. In general sleeve pneumonectomy has become an established procedure for treatment of lung cancer involving the carina and should be performed for carefully selected patients in experienced centers only.