The development of diffuse malignant pleural mesothelioma is associated with exposure to asbestos. The surgical treatment comprises a radical pleuropneumonectomy with resection of the pericardium and diaphragm (P3D) or palliative pleurectomy/decortication of the tumor. The prognosis in general is poor. P3D is most effective in patients with epithelial mesothelioma at an early stage. Complete resection has the best prognosis. Palliative tumor decortication is restricted to symptomatic patients with acceptable performance status. The prognosis of patients after radical resection is not significantly different from patients with pleurectomy/decortication. Preliminary results of multimodal therapy concepts, including additional chemo- and/or radiotherapy, suggest an improvement in survival. Nevertheless, so far treatment has been focused on the palliation of clinical symptoms like pain and dyspnee.