Aims : To increase awareness about the expanding pool of marginal candidates for lung cancer surgery. This pool includes patients with moderate to severe COPD, septuagenarians and octogenarians, patients with previous coronary surgery or stenting, and patients with previous pleural empyema or persisting intrapulmonary infection. Patients with a lung cancer recurrence also belong to this group. Adequate preoperative work up includes several medical specialties. The overall aim of the presentation is to provide an updated overview of the classical and novel technological tools that facilitate the preoperative selection of patients who are unfit for surgery.