Role of thoracoscopy, mediastinoscopy and laparoscopy in the diagnosis and staging of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is an aggressive malignancy with dismal prognosis. Unfortunately, chemotherapy only marginally extends patient survival and palliative care often remains the sole therapeutic option. Nonetheless, for a selected group of patients that present with an early disease stage and an epithelioid histology, a personally tailored multimodality therapeutic (MMT) protocol comprising of cyto-reductive surgery and chemotherapy with or without radiation therapy may significantly prolong survival. Accurately selecting patients for this aggressive therapeutic approach is challenging and is based in part on optimal pre-surgical staging. Here we discuss the role of thoracoscopy, mediastinoscopy and laparoscopy in the diagnosis and staging of MPM patients prior to definite surgical resection.