NEW YORK, (February 12, 2026) – A new study from the Icahn School of Medicine at Mount Sinai and the Mount Sinai Tisch Cancer Center finds that pleurectomy/decortication, a lung-sparing surgery, can be performed safely with low mortality in carefully selected patients with pleural mesothelioma, a rare and aggressive cancer most often caused by asbestos exposure.
The research, published this month in The Annals of Thoracic Surgery , offers a modern, data-driven counterpoint to the widely debated Mesothelioma and Radical Surgery 2 (MARS2) trial , which raised concerns about the role of surgery in mesothelioma care.
Researchers found zero in-hospital and 30-day mortality, and a 90-day mortality rate of 4.2 percent, substantially lower than rates reported in the MARS2 trial in 2024.
"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," said Raja M. Flores, MD, Professor of Surgery at the Icahn School of Medicine at Mount Sinai, Chair of Thoracic Surgery for the Mount Sinai Health System, and corresponding author of the study. "This study highlights that outcomes depend not only on whether surgery is performed, but how and in whom."
Dr. Flores' current work builds on nearly two decades of influential research that has helped shape the surgical management of pleural mesothelioma. In his landmark multi-institutional study published in 2008 analyzing outcomes from 663 patients, Dr. Flores and colleagues reported that patients undergoing pleurectomy/decortication demonstrated improved survival compared with those treated with extrapleural pneumonectomy, a far more radical operation involving removal of the lung.
At a time when extrapleural pneumonectomy was widely considered the standard surgical approach, 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 that paradigm shift, demonstrating that with modern imaging, rigorous preoperative evaluation, and careful surgical planning, pleurectomy/decortication can be performed with very low early mortality. Together, the studies trace an evolution in mesothelioma surgery; from questioning which operation offers the best long-term outcomes to establishing contemporary benchmarks for safety and patient selection.
The MARS2 trial reported higher early mortality and questioned the value of surgery for pleural mesothelioma. The 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 (a surgery associated with higher risk) were excluded.
Mesothelioma remains a devastating disease with limited treatment options, making it critical 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," said Dr. Flores. "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 Irving J. Selikoff, MD , a Mount Sinai physician-scientist, was instrumental in establishing the link between asbestos exposure and mesothelioma. His work led 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."
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. The study was conducted without external funding.
Full study: https://www.annalsthoracicsurgery.org/article/S0003-4975(26)00105-0/abstract
