Surgical resection remains the mainstay of treatment in lung cancer patients. Stratification of preoperative risk should be based on the functional status of pulmonary and cardiac systems usually damaged by cigarette smoking. Preoperative pulmonary evaluation should be performed taking into consideration the specific characteristics of the single patient and the type of surgery planned. Spirometry only may be required or oxygen consumption determination is necessary. Cardiac assessment should be based on clinical and instrumental examinations while invasive tests should be limited to high-risk patients. The potential difficulties in endotracheal intubation and lung isolation, the risk for desaturation during one-lung ventilation, and postoperative pain control should be analyzed.