The decision for surgical measures in bronchial carcinoma is mainly based on the preoperative assessment of the presumed tumour extent and cell type, as well as cardiopulmonary function. Bronchoscopy, as an obligatory procedure, allows a definite diagnosis in most of the cases, definition of the most proximal tumour extension and exclusion of bilateral endobronchial disease. Transbronchial needle aspiration can provide important information on lymph node involvement, although mediastinoscopy has the highest diagnostic yield and remains the standard procedure for lymph node staging. Thoracoscopy, providing a much higher sensitivity than thoracentesis, enables differentiation between malignant or para-malignant pleural effusion in almost all of the cases. Thus, endoscopy alone often demonstrates unresectability.