Patients requiring assessment for oncosurgery encounter a complex series of steps in their cancer journey [1–18]. Oncosurgery represents a challenge for cardiologist [19]. Several problems occur due to the extent and traumatic interventions in reflexogenic zones in patients with nutritive deficiency, hypovolaemia, anemia, electrolyte imbalance [20,21], metabolic complications and tumor lysis syndrome [21–24]. Increasing evidence focuses on perioperative arrhythmias [20,26–31], infective endocarditis and hospital-acquired infection prevention [32– 35], massive intraoperative blood loss treatment [35,36], thromboembolic event prevention [37–44], comorbidities and organ failure occurrence [25]. Arrhythmia is a common complication during the perioperative period [27] and various causes have been called in cause: age, cardiovascular history, heart rate variability fluctuation, sympathetic/parasympathetic imbalance [29], pulmonary dysfunction, pneumonectomy, extent/stage/time of surgery [27], inflammatory response [27] phosphorylation-dependent loss of acid-sensitive potassium channel TASK-1 (ITASK) current [31], and metabolic alterations [25]. Increased vigilance for perioperative QTc interval prolongation may be also warranted [30]. The majority of postoperative atrial fibrillation is uncomplicated and transient but one-third of the cases lead to persistence or major intervention [27]. Moreover, increasing infective endocarditis in cancer patients complicating previous chemotherapy is not uncommon and it is strongly associated with neutropenia, thrombocytopenia, immunosuppression, frequent bacteremia and cardiovascular toxicities [32–34,43–46] and research suggest that there is a need for hospital-acquired infection prevention and bacterial endocarditis prophylaxis in cancer patients to avoid serious consequences [32– 34]. The increased thromboembolism risk in cancer patients [38,40] is influenced by the type of cancer, its stage and histology, the presence of thrombophilia, concomitant treatments, metastatic-stage malignancy [45], vascular catheter presence [37], and paraneoplastic hypercoagulability [38,40,44]. Cardiovascular toxicities due to previous chemotherapy also increase the heavy burden of cancer patients represented by the concomitant risk factors [38,44–55]. Preoperative cardiological assessment is the cornerstone of themodern oncosurgery aswell as efficacious anesthesiological evaluation [28]. Cardiological risk estimation [46], identification of frail patients [37], optimalization of perioperative and also therapeutic strategies [39] associated with an efficacious anesthesiological and resuscitation care [35] can permit to decrease perioperativemorbidity andmortality [39–49] aswell as operative choice [55–57]. Patient-, cancer-, and treatment-related factors should be considered [39,44]. It is crucial that the lesson learned from each patient informs clinical decision making for the next patient care [58]. The author of this manuscript has certified that he adheres to the statement of ethical publishing as what appears in the International Journal of Cardiology.