Lack of evidence in malignant pleural mesothelioma surgery

Abstract

Eight hundred and two thoracic surgeons belonging to three international societies answered a self-administered on-line questionnaire focusing on their opinions of surgical management of malignant pleural mesothelioma (MPM); results of the survey are reported w1x. The present paper affords at least two different levels of interpretation, the first one being its ‘pure educational role’. About half of the responders admitted to not practise any form of extirpative wextrapleural pneumonectomy (EPP); or pleurectomyydecortication (PyD)x surgery for MPM. Therefore, the opinions of this subgroup of surgeons are obviously derived from a learned culture, which is directly influenced by the international literature or other forms of medical education. These participants are not able to refer to any personal experience. The other responders declared themselves to be experienced in MPM surgery and stated that they performed both EPP or PyD (352 surgeons world-wide, 170 from European countries). Although authors ensure that crude data are available in the ‘Thoracic Domain’ of the EACTS web-site, any attempt we made to see them was vain (even after e-mail contact with EJCTS Editors and EACTS web-master), therefore, a precise appraisal of the number of surgical proceduresy surgeon rate is not easy to assess. Because of the rarity of the disease w2x, and considering that surgical resection is feasible in a limited number of patients only (in particular when multimodality approaches are proposed), it is presumed that the number of surgeons declaring to be directly involved in the management of MPM perform these operations only occasionally. An occasional practise can not lead to objective conclusions about the therapeutic role of any surgical procedure. Among this sub-group of surgeons the influence of the international literature also weighs heavily. Moreover, the authors themselves stated that the high number of considered variables did not allow to proceed to a statistical analysis of the results of the study. On the basis of the above considerations, the ‘pure educational role’ of the present paper is limited.