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Radical surgery for malignant pleural mesothelioma: have we identified the appropriate selection tools?

The extensive utilization of asbestos in the previous century in industrialized countries, the rapid surge of asbestos use in developing countries and the omnipresence of asbestos containing materials in most man-made environments continue to contribute to the constantly increasing epidemic of malignant pleural mesothelioma (MPM) (1-3). Chronic inflammation elicited by inhaled asbestos fibers is considered the principal etiologic factor for this almost universally lethal malignancy originating in the pleura. It is assumed that 20-60 years (median around 40 years) of chronic inflammation is needed before this disease manifests itself (4). The direct consequence of this long latency period is that MPM is most frequently diagnosed at an older age (5). 
 
MPM is usually confined to one hemithorax at the time of diagnosis, but the disease has a strong tendency to spread and involve the entire pleura and interlobular space. Infiltration into adjacent structures is characteristic of advanced MPM and despite attempts to completely resect the affected pleura, MPM will recur in most cases.