In high-difficulty, high-complexity, and high-risk surgeries such as tracheal resection and reconstruction, the management of the anastomosis directly impacts the surgical outcomes and long-term quality of life for patients. However, there is currently a lack of comprehensive literature addressing this topic in the perioperative period. This article reviews the theoretical foundations both domestically and internationally, combined with the long-term practical experience from our center, aiming to provide a more complete strategy for anastomosis management in the perioperative period of tracheal reconstruction surgery.