Surgical resection has been offered for MPM since the 1950’s, although it has only been in the last 15 years that randomised trials have been initiated in order to investigate its roles. Any treatment for any condition in medicine is a balance of the risks and benefits, with it being possible to consider the benefits simply as quality and length of life. Unfortunately, the inevitable skill of surgeons in selecting carefully the youngest, fittest patients with early stage disease ingrains significant selection bias when considering the outcomes of non-randomised cohort studies. The second issue is the tendency for some authors and readers to overlook the difference between associative and causative effects.
This presentation will consider historical aspects of mesothelioma surgery, focusing on the definitions standardised by the IASLC: partial pleurectomy, pleurectomy decortication, extended pleurectomy decortication and extrapleural pneumonectomy. The evidence base for each option will be considered focusing on the potential benefits of quality and length of life balanced against the risks of surgery. Two randomised studies have been completed in the United Kingdom and two are currently recruiting. The results of the MesoVATS and MARS trials will be discussed in the current context, together with progress reports of the current MARS-2 and MesoTRAP studies.