Management of pleural diseases in the 21st century

Management of pleural diseases in the 21st century

Pleural pathologies have long remained diseases managed by thoracic surgeons. However, advances in modern technology and the development of new medical subspecialties have changed the contemporary landscape of these diseases. The last decade has seen a rise in trials demonstrating efficacy of non-operative management of parapneumonic empyema, despite guidelines recommending a surgery first approach. The benefits of radical therapies for mesothelioma have also come back into question. There is conflicting literature regarding initial management of primary spontaneous pneumothoraces with some literature advocating for observation and others recommending surgery on first presentation. This series will tackle some of these controversies and provide input from experts in the fields of benign and malignant pleural pathologies. This series will offer an update to readers on common pleural pathologies encountered by thoracic surgeons and what modern day management could entail.


Funding: None.


Provenance and Peer Review: This article was commissioned by the editorial office, Shanghai Chest for the series “Management of Pleural Diseases in the 21st Century”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at The series “Management of Pleural Diseases in the 21st Century” was commissioned by the editorial office without any funding or sponsorship. R.N. served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Shanghai Chest from August 2021 to July 2025. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See:

Rahul Nayak

Rahul Nayak, MD, FRCS(C) ORCID logo

Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada. (Email:

Keywords: Management; pleural diseases; mesothelioma

Received: 13 January 2024; Accepted: 28 February 2024; Published online: 22 April 2024.

doi: 10.21037/shc-24-2

doi: 10.21037/shc-24-2
Cite this article as: Nayak R. Management of pleural diseases in the 21st century. Shanghai Chest 2024;8:7.

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