CONCLUSIONS Sleeve resection of the trachea while preserving the paries membranaceus trachea appears useful for patients in whom papillary thyroid carcinoma has invaded as far as the tracheal mucosa. OBJECTIVE While tracheal sleeve resection with end-to-end anastomosis is advantageous, risks of suture failure or other serious complications exist. Since feeding arteries enter the trachea from the posterior and lateral walls, we conduct tracheal anastomosis preserving the paries membranaceus trachea. METHODS This study retrospectively examined therapeutic outcomes and postoperative complications for sleeve resection followed by end-to-end anastomosis in 12 patients between 1994 and 2005. RESULTS Tracheal suture failure occurred in one patient and sutures were redone. One patient developed esophageal fistula, but recovered with conservative treatment. One patient required re-intubation. In three patients, recurrent laryngeal nerves were paralyzed bilaterally. No patients displayed recurrence in the tracheal resection margin or preserved paries membranaceus trachea. The 10-year survival rate was 72.9%.