Here’s a bold statement: A groundbreaking study is challenging the status quo in mesothelioma treatment, offering a glimmer of hope for patients facing this aggressive cancer. But here’s where it gets controversial—while some trials have questioned the role of surgery, new research from Mount Sinai is flipping the script, proving that lung-sparing surgery can be both safe and effective for carefully selected patients. And this is the part most people miss: it’s not just about whether surgery is performed, but how and in whom it’s done that makes all the difference.
In a recent study published in The Annals of Thoracic Surgery, researchers from the Icahn School of Medicine at Mount Sinai and the Mount Sinai Tisch Cancer Center found that pleurectomy/decortication (P/D), a lung-sparing surgical approach, can be performed with remarkably low mortality rates in patients with pleural mesothelioma—a rare and often deadly cancer primarily caused by asbestos exposure. The study reported zero in-hospital and 30-day mortality, with a 90-day mortality rate of just 4.2 percent, significantly lower than the rates reported in the widely debated Mesothelioma and Radical Surgery 2 (MARS2) trial of 2024.
But why the stark difference in outcomes? The Mount Sinai team suggests it boils down to meticulous patient selection, advanced imaging techniques, and tailored surgical planning. For instance, nearly 80 percent of patients in their study had the epithelioid subtype of mesothelioma, which is known to respond better to surgery. Additionally, patients were rigorously evaluated preoperatively, and those requiring the more aggressive extrapleural pneumonectomy (EPP)—a surgery with higher risks—were excluded. This contrasts sharply with the MARS2 trial, where broader patient inclusion and a preference for more extensive operations may have contributed to higher mortality rates.
Dr. Raja M. Flores, the study’s corresponding author and a pioneer in mesothelioma research, emphasizes, ‘This study underscores that surgery isn’t a one-size-fits-all solution, but when performed thoughtfully, it can be a game-changer for the right patients.’ His work builds on nearly two decades of research, including a landmark 2008 study that first highlighted the benefits of P/D over EPP, a more radical surgery involving lung removal. At the time, EPP was the standard approach, but Dr. Flores’ research helped shift the paradigm, establishing lung-sparing surgery as a viable—and often preferable—option.
Here’s the kicker: Mesothelioma remains a devastating disease with limited treatment options, making studies like this all the more critical. While surgery isn’t suitable for everyone, this research reinforces its role as a key component of multidisciplinary care, especially at experienced, high-volume centers like Mount Sinai. The institution’s legacy in mesothelioma treatment dates back to Dr. Irving J. Selikoff, whose groundbreaking work in the 20th century established the link between asbestos exposure and mesothelioma, leading to modern asbestos regulations.
Today, Mount Sinai continues this legacy, treating patients exposed to asbestos during events like the September 11, 2001 attacks through the World Trade Center Health Program. The research team, including experts in thoracic surgery, epidemiology, and outcomes analysis, is now exploring how combining surgery with immunotherapy could further improve outcomes for mesothelioma patients.
But what do you think? Is lung-sparing surgery the future of mesothelioma treatment, or are there still too many unknowns? Share your thoughts in the comments—this is a conversation that deserves to be heard.
