Mr A is a 68-year-old man with a history of melena who was found to have a mass in his colon that was suspicious for possible malignancy. His 75-pack-year smoking history has resulted in a chronic daily cough and the diagnosis of chronic obstructive pulmonary disease. On physical examination, he has wheezes, decreased breath sounds, and a prolonged expiratory phase; his forced expiratory volume in the first second (FEV1) is 1.34 L (47% predicted). Mr A needs surgery for potentially curative treatment for presumed colon cancer, but he is understandably worried about the effect of his lung disease on his surgical risk. In particular, he is worried that he may not be able to be weaned off the ventilator after surgery. This discussion reviews the important patient- and procedure-related risk factors for pulmonary complications after surgery, the role of preoperative testing, and the evidence supporting strategies to reduce the risk of pulmonary complications as they apply to Mr A.