Compared to lunar missions, Mars missions will pose additional challenges. This includes a longer duration (currently anticipated to take around three years for a return mission), and a hazardous Martian environment with 0.38 Earth gravity, a thin atmosphere, and a weak magnetosphere. These factors contribute to extreme weather conditions, and significant exposure to space radiation. Evacuation to Earth for medical treatment will be impractical, rendering the capability to provide surgical interventions absolutely necessary. This paper is part of an ongoing scoping review of relevant published scientific literature to identify medical conditions that might require operative or non-operative surgical solutions during long-duration spaceflight. In the context of potential future Mars missions, onboard acute conditions, or newly developed chronic diseases (Type 1), and Mars surface/environment-related surgical conditions (Type 2), provide relevant considerations for future mission planning and crew safety. (Type 1) During long-duration spaceflight, exposure to space radiation and microgravity affects every organ system. This may result in a broad range of medical events requiring diverse operative or non-operative surgical interventions. The likelihood of acute life-threatening events (Type 1a.) is increased, and newly developed chronic diseases (Type 1b.) may also occur. If asymptomatic, but untreated, secondary sudden surgical emergencies may result. On reaching Mars (Type 2), reintroduction of partial gravity (0.38 G), flight-related reduced bone mineral density and potential changes in muscle mass, might lead to increased risk of lumbar disc herniations and traumatic injuries such as fractures. Without adequate space radiation shielding, surface conditions will likely increase the risk for development of malignancies and eye diseases such as cataracts. Communication delays (as long as 24 min each way) will require any immediate medical emergency to be managed in-situ by the expeditioners. Remotely operated robotic surgery is not currently feasible, as any communication lag >100 ms will cause a perceptible delay, potentially affecting surgical outcomes. The provision of healthcare for Mars missions will face unique challenges in terms of both a hostile and extreme environment, and a remote and isolated location without real-time Earth communication. The medical team will need to be equipped to manage a very wide range of health conditions, including low acuity, chronic, and high acuity life-threatening issues, with some potentially requiring surgical intervention. Issues for the treating team include appropriate skill sets and access to medical guidance, facilities, equipment and supplies, and available pharmaceuticals. These significant challenges underlie the importance of adequate anticipation, preparation and planning for the healthcare needs of Mars explorers.
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