Objective Tracheal reconstruction is usually performed for patients with defects caused by invasive thyroid carcinoma, tracheal cancer, and tracheal fistula. Various tracheal reconstructive methods have been reported. However, there are minimal reports on long-term outcomes of tracheal reconstruction. In our institution, soft tissue reconstruction was performed in patients with tracheal cartilage defects between 20-40%, and rigid reconstruction was performed for patients with 40-80% tracheal cartilage defect. This study analyzed mid-to-long-term changes in tracheal volume for patients undergoing soft tissue and rigid reconstructions, as well as the volume changes of transplanted costal cartilage in rigid reconstructions. Methods From April 2010 to March 2023, ten patients underwent tracheal reconstruction at Saitama Cancer Center (Saitama, Japan). Five patients with a 20-40% tracheal cartilage defect (Tr 1a) were treated with soft tissue reconstruction, and five patients with a 40-80% tracheal cartilage defect (Tr 2b) were treated with rigid reconstruction. The patients’ records were retrospectively reviewed. The volume changes of the reconstructed tracheal lumen, and the volume changes of transplanted costal cartilage were analyzed. Results All ten patients successfully underwent two-stage reconstruction without major complications. Though soft tissue reconstruction group showed variable change of tracheal lumen volumes, the volume generally increased over five years with no airway stenosis. In contrast, rigid reconstruction group maintained stable tracheal lumen volumes, and costal cartilage grafts showed slight early resorption, stabilizing thereafter. Conclusion There is no case show airway stenosis in both soft tissue reconstruction group and rigid reconstruction group. For rigid reconstruction, the combine of costal cartilage and forearm flaps effectively maintains tracheal patency. Costal cartilage suggested to be an appropriate graft selection for tracheal rigid reconstruction.