A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS)

Malignant pleural mesothelioma (MPM) incidence continues to rise in Europe [1]. The UK has one of the highest national incidences in the world, due to peak between 2011 and 2015 [2] and Western Australia is believed to have the highest regional incidence [3]. There is likely to be an increasing incidence of this disease in countries where asbestos use continues and where its use is not well-regulated [4]. There is an important role for thoracic surgeons in helping to provide a prompt and reliable diagnosis and in palliation of pleural fluid so surgeons will continue to be involved in the care of these patients, but the benefits of various forms of extirpative surgery are contentious and as yet unresolved. Consideration of clinical trials of surgery continues in the UK as a sequel to the Mesothelioma and Radical Surgery (MARS) trial [5] and across Europe as a sequel to European Organisation for Research and Treatment of Cancer (EORTC) 08031 [6]. In planning future studies, it is essential to gauge the prior beliefs and opinions of surgeons; recruitment is inevitably difficult and a randomised study of an intervention is only achievable where there is some balance of prior belief for and against effectiveness. The Thoracic Domain of the European Association for Cardio-Thoracic Surgery (EACTS) proposed a survey of opinions and beliefs on the perceived effects and benefits of different surgical strategies; the survey was adopted by the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS). It should be noted that the survey was completed before MARS or EORTC 08031 results were known.