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Standardizing surgical treatment in malignant pleural mesothelioma.

www.annalscts.com Of all thoracic malignances, the management of mesothelioma is perhaps the most controversial, and this is especially true with respect to surgical treatment. Mesothelioma is a relatively rare disease with only 2,500 new cases being diagnosed each year in the United States, making it difficult to perform large scale prospective, let alone randomized studies that can provide level I evidence. The disease is extremely heterogeneous, with histological subtype having a major impact on overall survival. Even within individual tumors, there may be regional variation in the percentages of epithelioid to non-epithelioid components, making pretreatment biopsies often inaccurate. Beyond tumor subtype, the natural history of the disease often differs from patient to patient. Some patients present with relatively low volume indolent disease, whereas others have bulky tumors that behave in a much more aggressive fashion.