For a least a decade, many patients have benefitted from new indications of major thoracic surgery owing to improvements in the surgical and anesthetic procedures of thoracic surgery. Identification of risk factors of perioperative morbidity and mortality becomes of paramount importance when trying to lesson the postoperative mortality rate to 1% or less. The careful assessment of the candidates for thoracic surgery with a multidisciplinary approach is the cornerstone of such an objective. The lower mortality rate should be achievable with a preoperative preparation of the patients of a rehabilitation and nutritional program and a pharmacologic treatment optimization.