Background With the increasing demand for cancer care and advancements in digital health, telemedicine has emerged as a promising tool to enhance healthcare accessibility and efficiency. Its application in pre-anesthesia consultations (PAC) has the potential to address logistical challenges while maintaining clinical quality. Purpose This study assesses whether telemedicine is a non-inferior alternative to traditional face-to-face pre-anesthesia consultations (PAC) for cancer surgery patients at a tertiary care center and evaluates discrepancies between PAC findings and pre-surgical assessments. Methods This prospective, randomized non-inferiority study included patients aged 20 years or older with access to internet and video calling. The participants were randomly allocated to either a telemedicine PAC or a face-to-face PAC group in a 1:1 ratio. An eight-item questionnaire on a 10-point scale was used to measure patient satisfaction after the consultation, while a 12-item questionnaire on the same scale assessed anesthesiologists' satisfaction. We also compared airway examination findings between the PAC and pre-surgical assessments to detect any discrepancies. Results Of 120 patients assessed, 100 met the inclusion criteria and were randomized (50 per group). Baseline characteristics were similar across groups. Physician satisfaction scores were comparable between telemedicine and face-to-face consultations (7.18 versus 7.58, p=0.113), as were patient satisfaction scores (6.94 versus 7.26, p=0.251). Airway examination findings were consistent, with no significant discrepancies. Conclusion Telemedicine was found to be non-inferior to face-to-face consultations for pre-anesthesia assessments in terms of patient and physician satisfaction, as well as clinical accuracy. These findings support the integration of telemedicine into routine pre-anesthesia practice, particularly in high-demand settings such as cancer care. Further research is warranted to evaluate broader clinical outcomes and cost-effectiveness.