A groundbreaking study published by researchers at the Icahn School of Medicine at Mount Sinai and the Mount Sinai Tisch Cancer Center has demonstrated that pleurectomy/decortication, the less aggressive, lung-sparing surgery for pleural mesothelioma patients, can be performed safely, with remarkably low mortality rates, when patients are carefully selected. These findings, which contradict those of the oft-noted 2024 MARS2 trial, offer renewed hope for those diagnosed with this aggressive asbestos-related cancer.
Mesothelioma Study Reports Zero 30-Day Mortality with P/D Surgery
Pleurectomy/decortication (P/D) is a two-stage procedure used to treat pleural mesothelioma. Unlike the more aggressive extrapleural pneumonectomy procedure, which removes an entire lung, pleural tissue, lymph nodes, and part of the diaphragm, P/D is often called a lung-sparing surgery because it removes as much diseased tissue as possible without removing the entire lung. The use of both surgeries was called into question after the 2024 MARS2 trial raised concerns about higher early mortality than what was experienced by patients being treated with less invasive, non-surgical protocols. The Mount Sinai research, published in The Annals of Thoracic Surgery, counters these conclusions.
The Mount Sinai study found mesothelioma surgical outcomes following P/D that were substantially lower than the rates reported in MARS24. After finding zero in-hospital and 30-day mortality among carefully selected mesothelioma patients who’d undergone pleurectomy/decortication, and only a 4.2% mortality rate at 90 days, Dr. Raja M. Flores, Professor of Surgery at Icahn School of Medicine at Mount Sinai, and Chair of Thoracic Surgery for the Mount Sinai Health System, said, “Our findings show that pleurectomy/decortication can be done safely when patients are carefully selected and surgery is tailored to balance tumor removal with the patient’s ability to tolerate aggressive treatment.”
Mesothelioma Patient Selection Key to Surgical Success
The research team from Mount Sinai Tisch Cancer Center suggests that differences in mesothelioma patient selection, imaging use, tumor subtype, and surgical approach—including MARS2’s preference for more extensive operations—may have contributed to that trial’s concerning outcomes. In the Mount Sinai study, nearly 80% of the mesothelioma cohort were identified as having the epithelioid subtype of the disease, which responds better to surgical treatment than other variants. Each patient underwent rigorous preoperative testing, and those requiring extrapleural pneumonectomy—a more radical mesothelioma surgery involving complete lung removal and associated with higher mortality risk—were excluded.
Dr. Flores’s current research builds on his landmark 2008 multi-institutional mesothelioma study, which analyzed 663 patients and found that those undergoing pleurectomy/decortication demonstrated improved survival compared with those receiving extrapleural pneumonectomy. The study helped redefine surgical standards and validated lung-sparing surgery as preferable for appropriately selected patients at a time when lung removal was the standard approach.
Regarding mesothelioma treatment options, Dr. Flores said, “Surgery is not for everyone, but for the right patients, it can be both safe and meaningful.” The research team is currently expanding on its work and offering additional hope for mesothelioma patients by studying outcomes from combining surgery with immunotherapy.
Finding the right treatment is just part of the journey for mesothelioma patients. If you or someone you love has been diagnosed with this challenging asbestos-related disease, contact the Patient Advocates at Mesothelioma.net for more help. We’re at 1-800-692-8608.
