Better survival was evident in patients with surgery for recurrent disease to the pleura (first pleural surgery/Scenario 1). In this patient cohort, 18.2% EPPs, 2.2% TCs and 6.8% incomplete resections were performed in contrast to 29.9% EPPs, 15.0% TCs and 29.9% incomplete resections in patients with primary pleural surgery (Scenario 2). There is an obvious bias in disease severity and the resulting invasiveness of the necessary surgical procedure that may not allow a fair comparison of these patient cohorts. Nevertheless, it demonstrates again the excellent outcome of surgery for recurrent disease to the pleura [10]. One might also speculate about different biology of TETs presenting with pleural involvement at first diagnosis or that patients in institutional follow-up programmes after thymic surgery (tertiary prevention) are diagnosed earlier with recurrence than patients with TETs with pleural involvement without prior thymic surgery (no primary prevention).