In 2003 we began a study to determine if aprotinin decreased the blood lost during extrapleural pneumonectomy for mesothelioma.We knew from the cardiac literature that it had decreased the blood lost with complex operations but it had not been studied for non-cardiac thoracotomy.The study was terminated after 20 patients when aprotinin was withdrawn due to concerns with a possible increase in death after cardiac surgery.(BART trial).The trial did enable us to prove that aprotinin decreased blood loss in this model.Interestingly all the placebo group had died by the time we published and led to the supposition that aprotinin may have improved survival.(Cancer 2009).This is not the first time aprotinin has been suggested to improve cancer outcome.In 1999 Lentschener published a sub-group analysis of patients having liver resection where blood loss was being investigated (Fibrinolysis & Proteolysis 1999).The patients with metastatic colon cancer lived longer if they received aprotinin rather than placebo.Again in 2001, but only in abstract form it was suggested that patients who received aprotinin for esophagectomy seemed to live longer.Aprotinin decreases blood loss.It also may interfere with mesothelioma spread by affecting the expression of-urokinasetype plasminogen activator.As an anti-neoplastic agent it must be quite weak..Later in this symposium I would like to suggest that another withdrawn drug, the COX-2 inhibitor, rofecoxib also creates a tendency to improved survival.What would happen if during cancer surgery a specific anti-tumor agent targeted for the patients cancer was administered with the specific intention of destroying micro-metastases that likely are created when the tumor is manipulated and excised?As an analogy when operating on infected tissue, systemic antibiotics improve survival by destroying bacteria released from the wound site.This is accepted and evidence-based.Perioperative and more specifically intraoperative chemotherapy may be what is next.Potentially this could affect wound healing.On the other hand if it improved long-term survival the risk might be very worth pursuing.Specific gene-targeted chemotherapy would have the greatest chance of improving outcome and perhaps would have less likelihood of affecting normal tissues and the healing process.