[New challenges in thoracic surgery as exemplified in asbestos exposure and mesothelioma treatment]

The increasing production and use of asbestos has induced a steadily increasing incidence of malignant mesothelioma. Diagnostic difficulties persist and the disease may remain undiagnosed in spite of multiple fluid aspirations and percutaneous needle biopsies. Thoracic surgery efficiently contributes to the diagnostic yield by thoracoscopy and, with unilateral disease, in functionally operable patients, preferably by diagnostic thoracotomy. In suitable patients this can be extended to either palliative tumour pleurectomy or total pleuro-pneumonectomy en bloc with resection of the pericardium and the diaphragm. The primary mortality of this procedure has dropped from formerly thirty to now well below 10% for both types of resection. Along with any kind of thoracotomy a lung biopsy should be performed for search of asbestos bodies in the parenchyma. This will facilitate not only the differential diagnosis but also the answer to the question of aetiology in support of the patients' and their families' claim for compensation to be paid. Unfortunately, although surgery has advantages compared to chemo- or radiotherapy and improves the quality of life, it fails to achieve cure except in a few favourable cases.