The somatic functional capacity can be defined as an organ-specific functional reserve. Statistical studies have shown perioperative risks in reciprocal relationship to this limit. A stepwise (graduated) approach for the assessment of cardiac and pulmonary function is suggested, which depends on the estimated risk. Indications for surgical therapy and operability, especially in the treatment of tumors and for geriatric patients, are not only determined by the somatic functional capacity but also by multiple other conditions.