Abstract Background Extensive airway involvement in thyroid cancer is associated with poor prognosis and constitutes one of the main causes of mortality. Airway replacement based on the implantation of stented aortic matrices emerges as a novel tool in the treatment of primary tracheobronchial malignancies and tracheal involvement in advanced thyroid cancer. Methods We conducted a retrospective cohort study including patients who had tracheal replacement with a stented aortic matrix for advanced thyroid cancer with (crico)-tracheal invasion at our centre. Cryopreserved aortic allografts were used for tracheal reconstruction. To prevent airway collapse, silicone stents were placed inside the grafts. The bioprostheses were covered with local muscle flaps. No immunosuppressive therapy was required. Results Over 5 years, 10 patients underwent tracheal replacement with stented aortic matrices. 2 patients underwent a concomitant thyroidectomy with neck dissection and 8 had thyroidectomy prior to airway replacement and presented with recurrence. A R0 resection was achieved in all patients. There were no cases of perioperative mortality. At a median follow-up of 19 months, 8 patients were alive and breathing and speaking normally. 2 patients died of causes unrelated to the graft. De novo generation of pseudocartilage was observed within the grafts. Conclusion Tracheal resection using stented aortic allografts is a simple and efficient technique of tracheal replacement that is becoming part of standard care at our institution. This approach allows for a R0 resection in advanced thyroid malignancies considered thus far as non-resectable.