NEW YORK, (February 12, 2026) – A groundbreaking study from the Icahn School of Medicine at Mount Sinai and the Mount Sinai Tisch Cancer Center has revealed that pleurectomy/decortication, a lung-sparing surgical procedure, can be performed safely with low mortality rates in carefully selected patients suffering from pleural mesothelioma. This rare and aggressive cancer is most commonly linked to asbestos exposure.
The research, published in the February edition of The Annals of Thoracic Surgery, provides a data-driven counterargument to the controversial Mesothelioma and Radical Surgery 2 (MARS2) trial. The MARS2 trial had previously raised questions about the role of surgery in the treatment of mesothelioma. In contrast, Mount Sinai’s study reported zero in-hospital and 30-day mortality rates, with a 90-day mortality rate of just 4.2 percent, significantly lower than the figures reported by the MARS2 trial in 2024.
New Insights into Mesothelioma Surgery
“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,” stated Dr. Raja M. Flores, Professor of Surgery at the Icahn School of Medicine at Mount Sinai and Chair of Thoracic Surgery for the Mount Sinai Health System. Dr. Flores, the corresponding author of the study, emphasized that “outcomes depend not only on whether surgery is performed, but how and in whom.”
Dr. Flores’ work builds on nearly two decades of influential research that has significantly shaped the surgical management of pleural mesothelioma. His landmark multi-institutional study published in 2008 analyzed outcomes from 663 patients and found that those undergoing pleurectomy/decortication had improved survival rates compared to those treated with the more radical extrapleural pneumonectomy, which involves the removal of the lung.
Historical Context and Evolution of Treatment
At the time of its publication, the 2008 study played a pivotal role in redefining the field by validating lung-sparing surgery as a legitimate and often preferable strategy for appropriately selected patients. The newly published data extend this paradigm shift, demonstrating that with modern imaging, rigorous preoperative evaluation, and careful surgical planning, pleurectomy/decortication can be performed with very low early mortality.
The MARS2 trial had reported higher early mortality rates and questioned the value of surgery for pleural mesothelioma. However, Mount Sinai researchers suggest that differences in patient selection, imaging use, tumor subtype, and surgical approach, including a preference for more extensive operations, may have contributed to those outcomes.
“In the Mount Sinai cohort, nearly 80 percent of patients demonstrated the epithelioid subtype of mesothelioma, which is known to respond better to surgical treatment. All patients underwent rigorous preoperative testing, and patients undergoing extrapleural pneumonectomy were excluded.”
Implications for Future Treatment
Mesothelioma remains a devastating disease with limited treatment options, making it crucial to identify approaches that can safely improve outcomes. “This study reinforces that surgery should remain part of the conversation for mesothelioma treatment and can lead to long-term survivorship,” Dr. Flores noted. “At experienced, high-volume centers, pleurectomy/decortication can be an effective component of multidisciplinary care.”
Mount Sinai has a longstanding legacy in mesothelioma research and treatment. The late Dr. Irving J. Selikoff, a Mount Sinai physician-scientist, was instrumental in establishing the link between asbestos exposure and mesothelioma, leading to modern asbestos regulations. Today, Mount Sinai continues that legacy through one of the largest mesothelioma programs in the world, including care for patients enrolled in the World Trade Center Health Program following exposure during the September 11, 2001, attacks.
“These results offer hope and clarity for patients facing a difficult diagnosis,” said Dr. Flores. “Surgery is not for everyone, but for the right patients, it can be both safe and meaningful.”
Looking Ahead
The study was conducted by a multidisciplinary team from the Icahn School of Medicine and the Mount Sinai Tisch Cancer Center. The authors include Emanuela Taioli, MD, PhD; Stephanie Tuminello, PhD, MPH; Andrea Wolf, MD; Shubham Gulati, MS; and Jai Mehrotra-Varma, BS, representing expertise in thoracic surgery, clinical research, epidemiology, and outcomes analysis.
The research team is currently expanding this work by studying outcomes associated with combining surgery and immunotherapy for pleural mesothelioma. Notably, the study was conducted without external funding, underscoring the commitment of Mount Sinai to advancing treatment options for this challenging disease.
For more detailed information, the full study can be accessed at The Annals of Thoracic Surgery.
