According to an accompanying Comment, the MesoVATS trial provides important data that should deter routine referral of patients with malignant pleural mesothelioma (MPM) for surgery. When interpreted together with the published MARS (Mesothelioma And Radical Surgery) trial which reported that extrapleural pneumonectomy (EPP) was associated with worse outcomes and shorter median survival than in the no surgery group, a clear pattern begins to emerge: neither the most (EPP) nor least (VAT-PP) aggressive form of surgical resection confers survival benefits in patients with MPM- the more aggressive the procedure, the more complications it produces and the more detrimental it is to clinical outcomes. It is hoped that these findings will avoid subjecting future patients to unnecessary surgical morbidity and mortality; and surgical resection of MPM should be regarded as experimental, and only carried out within rigorous, high-quality clinical trials.