Surgery for pleural disease encompasses a wide range of procedures including diagnostic and therapeutic options for benign and malignant conditions. Advances in medical thoracoscopy have seen a reduction in surgical diagnostic and palliative procedures. Advances in surgery have led to an increase in the use of VATS as an approach in surgically managed pleural disease. VATS is established as the treatment of choice where surgical management of pneumothorax is indicated, although the timing of intervention is subject to continued debate. VATS approaches have expanded to stage III as well as stage II disease in empyema. Vacuum devices show encouraging results in patients with a persistent space requiring open-window treatment. Decortication may also be indicated for chronic, diffuse pleural thickening. Surgical resection of malignant pleural disease remains a matter of research and contention, with RCTs exploring roles in mesothelioma. There is low-level evidence examining the roles of surgery in other aspects of malignant pleural disease, such as pleural metastases from thymoma and nonsmall cell lung cancer.

Cite as: Belcher E, Edwards JG. The role of surgery. In: Maskell NA, Laursen CB, Lee YCG, et al., eds. Pleural Disease (ERS Monograph). Sheffield, European Respiratory Society, 2020; pp. 263–281 [https://doi.org/10.1183/2312508X.10024419].