Mount Sinai P/D Surgery: Zero Mortality in Study
Mount Sinai reports zero perioperative mortality for pleurectomy/decortication in mesothelioma, challenging MARS2 trial skepticism.
A new study from Mount Sinai Health System reports zero in-hospital and 30-day mortality for pleurectomy/decortication (P/D) in carefully selected people with pleural mesothelioma. The results directly challenge findings from the controversial MARS2 trial, which questioned whether surgery has a role in treating this disease.
Published in the February 2026 issue of the Annals of Thoracic Surgery, the study is led by Dr. Raja M. Flores, Chair of Thoracic Surgery at Mount Sinai. It presents data from one of the highest-volume mesothelioma surgical centers in the country.
Key Findings
The study, titled “Disaster on MARS2? Lessons Learned from Modern Day Outcomes,” reports outcomes from Mount Sinai’s experience with P/D, a lung-sparing surgical approach that removes tumor lining from the chest wall and lung surface while preserving the underlying lung.
Key results include:
- Zero perioperative mortality at both in-hospital and 30-day time points
- 4.2% mortality at 90 days, far below rates reported in the MARS2 trial
- Nearly 80% of surgical candidates had the epithelioid subtype, which tends to respond better to treatment
- Low overall complication rates attributed to rigorous patient selection
Why This Matters
Pleurectomy/decortication is a lung-sparing alternative to extrapleural pneumonectomy (EPP), which involves removing the entire lung along with surrounding tissue. P/D preserves the lung, typically resulting in shorter hospital stays, fewer complications, and better quality of life.
The MARS2 trial, published in 2024, reported concerning mortality rates for P/D and questioned whether surgery improved outcomes compared to chemotherapy alone. Those findings led some oncologists to reconsider surgical options for their patients.
Dr. Flores’ data suggests that the difference lies not in the surgery itself but in how candidates are selected and where the procedure is performed. Mount Sinai’s protocol emphasizes advanced imaging, thorough preoperative evaluation, and video-assisted thoracic surgery (VATS) techniques refined over two decades.
Pleurectomy/decortication removes the pleural lining and visible tumors while keeping the lung. Extrapleural pneumonectomy removes the lung entirely. Dr. Flores’ 2008 multi-institutional study of 663 patients found P/D provided better survival than EPP, and his team has advocated for lung-sparing approaches since.
The Role of Patient Selection
The study underscores that not every person with mesothelioma is a candidate for surgery. Mount Sinai’s selection criteria focus on histological subtype (epithelioid tumors respond most favorably), disease stage (earlier-stage disease with limited spread), and overall fitness to tolerate the procedure safely. CT, PET scans, and pulmonary function tests guide the final decision.
By concentrating on patients most likely to benefit, the team achieved outcomes that dramatically outperformed broader surgical cohorts.
Looking Ahead
Dr. Flores’ team is expanding their work to combine surgery with immunotherapy. Mount Sinai is pursuing clinical trials that pair P/D with checkpoint inhibitors, aiming to improve long-term survival beyond what surgery or drug therapy achieves alone.
The results reinforce that surgical treatment should remain part of the discussion for eligible people with mesothelioma, particularly at high-volume centers with dedicated thoracic oncology programs. For those considering treatment options, seeking evaluation at a center experienced in mesothelioma surgery is an important first step.
References
Annals of Thoracic Surgery. Disaster on MARS2? Lessons Learned from Modern Day Outcomes of Surgery for Pleural Mesothelioma.
https://pubmed.ncbi.nlm.nih.gov/41638523/
ScienceDirect / Annals of Thoracic Surgery. Disaster on MARS2? Lessons Learned from Modern Day Outcomes.
https://www.sciencedirect.com/science/article/abs/pii/S0003497526001050
Mount Sinai Health System. Mount Sinai Study Strengthens Landmark Evidence Supporting Lung-Sparing Surgery Offering Hope for people with mesothelioma.
https://www.mountsinai.org/about/newsroom/2026/mount-sinai-study-strengthens-landmark-evidence-supporting-lung-sparing-surgery-offering-hope-for-mesothelioma-patients
Reader Q&A
Frequently Asked Questions
What is pleurectomy/decortication?
Pleurectomy/decortication (P/D) is a lung-sparing surgery for pleural mesothelioma. It removes the pleural lining and visible tumors from the chest cavity while preserving the underlying lung. This contrasts with extrapleural pneumonectomy (EPP), which removes the entire lung.
What did the Mount Sinai study find?
The study reported zero in-hospital and 30-day mortality for P/D in carefully selected patients, with 4.2% mortality at 90 days. These results significantly outperform rates from the MARS2 trial and support P/D as a safe option at experienced centers.
What was the MARS2 trial?
MARS2 was a randomized trial published in 2024 that compared P/D plus chemotherapy to chemotherapy alone for mesothelioma. It reported higher-than-expected surgical mortality and questioned whether P/D improved survival, leading to debate among thoracic surgeons and oncologists.
Who is eligible for P/D surgery?
Candidates typically have epithelioid-subtype mesothelioma, earlier-stage disease, and sufficient overall health to tolerate surgery. Evaluation at a high-volume center with advanced imaging and pulmonary function testing is essential for determining eligibility.
How close are we to curing mesothelioma?
No cure exists for mesothelioma, as confirmed by the National Cancer Institute. Immunotherapy combinations like nivolumab plus ipilimumab, approved by the FDA as first-line treatment for unresectable pleural mesothelioma, have improved 3-year overall survival to 25% in trials compared to 17% with chemotherapy alone. Emerging therapies such as ADI-PEG 20 (pegargiminase) with chemotherapy extended survival 4 times longer at 3 years in a 2024 trial, while over 80 clinical trials test vaccines, gene therapy, and targeted approaches. These advances extend median survival beyond 18 months for many people with mesothelioma, but long-term remission remains unproven.
How did Steve McQueen get mesothelioma?
Steve McQueen was exposed to asbestos through multiple occupational and military sources over several decades. His primary exposure occurred during his service in the U.S. Marine Corps from 1947 to 1950, when he worked aboard naval ships and in shipyards, including removing asbestos lagging from pipes at Camp Lejeune. After his military service, he encountered additional asbestos exposure on movie soundstages where insulation contained the mineral, while wearing flame-resistant racing suits made with asbestos, and while working on race car and motorcycle brakes. McQueen did not develop symptoms until 1978, nearly 30 years after his initial military exposure, reflecting the typical latency period of 20 to 50 years between asbestos exposure and mesothelioma diagnosis. He was diagnosed with pleural mesothelioma in December 1979 and died in November 1980 at age 50.
What is the best hospital for mesothelioma treatment?
University of Texas MD Anderson Cancer Center ranks No. 1 in the U.S. for cancer treatment in 2025, for the fifth consecutive year, and treats more people with mesothelioma than nearly any other center. Other highly ranked hospitals for pleural mesothelioma include Brigham and Women’s Hospital and Massachusetts General Hospital, while Mayo Clinic-Rochester leads for peritoneal mesothelioma. People with mesothelioma receive care at these centers, which offer multidisciplinary teams and access to clinical trials. Rankings from U.S. News & World Report reflect factors like patient outcomes and expertise volume.