This article presents a structured approach to the preoperative assessment of patients for thoracic surgery. Essential points in the initial and final preanesthetic evaluations are explained. This information can be used to stratify the patients' risk and to guide perioperative management.

Preoperative anesthetic assessment before chest surgery is a continually evolving science and art. Recent advances in anesthetic management, surgical techniques, and perioperative care have expanded the envelope of patients now considered to be operable (Figure 1).<sup>57 Olsen G.N. Lung cancer resection: Who’s inoperable? Chest 1995 ;  108 : 289-290

Cliccare qui per andare alla sezione Riferimenti</sup> This article is an update of preanesthetic assessment for pulmonary resection surgery for patients with cancer. The principles described apply to all other types of nonmalignant pulmonary resections and to other chest surgery. The major difference is that, in patients with malignancy, the risk-benefit ratio of canceling or delaying surgery pending other investigation or therapy is always complicated by the risk for further spread of cancer during any extended interval before resection. Cancer surgery is never completely elective surgery.

Although 87% of patients with lung cancer die of their disease, the 13% cure rate represents approximately 26,000 survivors per year in North America. Surgical resection is responsible for essentially all of these cures. A patient with a resectable lung cancer has a disease that is still local or local-regional in scope and that can be encompassed in a plausible surgical procedure. An operable patient is someone who can tolerate the proposed resection with acceptable risk.<sup>32 Johnston M.R. Curable lung cancer Postgrad Med 1997 ;  101 : 155-165

Cliccare qui per andare alla sezione Riferimenti</sup> Several general points should be appreciated in the assessment of patients undergoing pulmonary resection.