Aims: To evaluate the anatomical and functional outcomes of tracheal resection with primary end-to-end anastomosis in patients with cervical tracheal stenosis, with a focus on airway patency, decannulation success, vocal cord function, and postoperative complications. Methodology: A prospective cohort study was conducted at Cho Ray Hospital, Vietnam, from 2018 to 2024. Patients diagnosed with cervical tracheal stenosis and undergoing segmental tracheal resection with primary end-to-end anastomosis were included. Preoperative evaluation included stenosis length, vocal cord mobility, and prior airway interventions such as dilation, resection, or stenting. Postoperative outcomes were assessed based on decannulation success, airway patency, vocal cord function, complication rates, and follow-up airway status. Results: A total of 92 patients were included, with a mean age of 43 ± 12 years. Post-intubation injury was the predominant etiology (90.2%). Stenosis length was 2–4 cm in 82.6% of patients and greater than 4 cm in 17.4%. Previous airway interventions were reported in 23.9% of cases. Surgery was performed as the primary definitive treatment in 76.1% of patients. Postoperatively, 89.1% of patients demonstrated normal vocal cord mobility, while 10.9% developed unilateral vocal cord paralysis. No cases of bilateral vocal cord paralysis or perioperative mortality were observed. All patients achieved successful decannulation and maintained satisfactory airway patency during follow-up. Conclusion: End-to-end tracheal anastomosis is a highly effective surgical technique for managing cervical tracheal stenosis. It ensures excellent airway restoration, high decannulation rates, and preservation of vocal cord function, with minimal complications. This approach should be considered the standard surgical option in appropriately selected patients.