New Perspectives in Thoracic Surgery for Malignant Pleural Mesothelioma

Dear Colleagues,

Through the decades, mesothelioma surgery has been performed to diagnose disease, remove tumors (aggressive surgery such as extra-pleural pneumonectomy, or lung-sparing tumor-removing surgery, such as pleurectomy/decortication), or improve symptoms (palliative surgery). In a real-world multidisciplinary setting, many authors have reported that some long-term survivors benefit from surgery.

This Special Issue aims to understand what could happen in the future years, trying to foresee the trends in future  mesothelioma surgical treatments. We also would like to understand how to improve MDT, preoperative study, anesthesia, postoperative rehabilitation, palliation, and follow-up. Furthermore, is there a role for Artificial Intelligence in the treatment of mesothelioma? 

Simply put: should we leave surgery or could it still be somewhat useful? Which type of surgery, if any? It is widely recognized that a truly complete resection is not possible, and that neither an extrapleural pneumonectomy (EPP) nor a radical pleurectomy/decortication (P/D) can eradicate all residual microscopic tumour.

Recently, a strong debate has been going on following the IASLC presentation of the results of the MARS2 trial, which compared survival for two groups of pleural mesothelioma patients: one group had chemotherapy with surgery, and the other had chemo without surgery.

The MARS2 clinical study results were presented at the IASLC 2023 meeting, and the lead author, Dr.Lim, proposed eliminating surgery for patients affected by malignant pleural mesothelioma, so extending survival of 28%.

Dr. Lim stated: “Classifying this disease as [inoperable] from the outset would increase access to more effective systemic treatments to improve survival for patients with other stages of disease.”

However, the commentary of Dr. Ugalde Figueroa raised important questions about MARS2 data and analysis:

• No true survival difference beetween the group: median survivals differed between the two groups, but not significantly.
• Patient characteristics were unequal between groups: the surgery group had a higher percentage of patients with significant risk factors, possibly leading to an increase in postoperative unfavourable outcome.
• The treating hospitals lacked experience: “Would the outcome be different in exclusively high-volume centers?”

We are solicitings clinical trials’ reports or projects, study designs, case series, technical “how-to-do-it” articles, narrative and systematic reviews, expert commentaries.

Dr. Paolo Scanagatta
Guest Editor

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• thoracic medicine
• thoracic surgery
• pleural mesothelioma
• chemotherapy
• oncology
• thoracic anesthesia