<\/p>\n
A national panel of 15 mesothelioma specialists across surgery, medical oncology, radiation oncology and pathology reached a consensus and issued new guidelines for surgery. The experts reviewed 116 studies and data from 630 mesothelioma surgeries between 2015 and 2025. After 3 rounds of formal voting, the panel challenged reluctance to recommend mesothelioma surgery following a controversial 2025 trial.<\/p>\n
The 2025 trial, known as the MARS2 trial<\/a>, concluded that chemotherapy followed with lung-sparing surgery didn\u2019t extend survival more than receiving chemo alone. Dr. Jeffrey Velotta<\/a>, lead author of the consensus document, tells us fallout from that trial was swift.<\/p>\n \u201cReferrals all of a sudden were stopping,\u201d Dr. Velotta says. \u201cAll of a sudden everything mesothelioma just went off the face of the earth. We wouldn\u2019t even get a chance to speak to these patients about the option of surgery. They weren\u2019t even given that option anymore.\u201d<\/p>\n The panel\u2019s consensus, which the Society of Thoracic Surgeons has published, counters the idea that mesothelioma surgery<\/a> doesn\u2019t offer benefits. Their message is clear: Surgery offers benefits, but the key is it must be recommended for the right pleura patients, be done the right way and involve the right surgical team.<\/p>\n Why the Panel Came Together<\/p>\n Dr. Velotta doesn\u2019t dismiss the MARS2 trial outright. He says it exposed a real gap in patient selection. Many people with pleural mesothelioma<\/a> studied in the trial underwent surgery without a prior PET scan, so some had more advanced disease than doctors realized going in.<\/p>\n \u201cThey ended up operating on a lot of patients that were stages 3 or 4<\/a>,\u201d Dr. Velotta explains. \u201cIf they would have gotten a PET scan, they may not have needed surgery.\u201d\u00a0<\/p>\n To push back against a blanket no-surgery stance, the Society of Thoracic Surgeons assembled 15 of the field\u2019s most experienced mesothelioma specialists<\/a>. The panel deliberately excluded surgeons with only occasional exposure to the rare cancer.<\/p>\n Why Lung-Sparing Surgery Now Comes First<\/p>\n The panel was unambiguous on one point: Surgery that spares the lung is the preferred approach. A pleurectomy\/decortication<\/a> removes the cancerous lining while leaving the lung in place.<\/p>\n Dr. Velotta shares the example of his early-stage patient, Lawanda Ultan<\/a>, who tolerated the lung-sparing surgery well at 93 years old. He suggests it\u2019s unlikely she would have had the same successful outcome with a more aggressive surgery.<\/p>\n The panel consensus leans toward a less aggressive version of even the preferred surgery. Surgeons have traditionally removed the diaphragm and the lining around the heart as routine. The panel now favors preserving both when possible.<\/p>\n \u201cIt\u2019s harder on the surgeon, but better recovery for the patient,\u201d Velotta tells us, adding that the shift changed his own approach. \u201cBefore this consensus, I\u2019d be much more aggressive about removing the diaphragm.\u201d<\/p>\n The panel was very clear on its position regarding the\u00a0 operation that removes the entire lung, called extrapleural pneumonectomy<\/a>. They said its use should be rare.<\/p>\n \u201cWhen you remove everything, there\u2019s just higher complication rates,\u201d Dr. Velotta explains. \u201cPatients don\u2019t have as much reserve to recover, and they just do worse.\u201d<\/p>\n \n Dr Velotta with Lawanda Ultan. Image courtesy of Dr. Velotta\n <\/p>\n Why a Full Medical Team and the Right Surgeon Matter<\/p>\n The consensus places heavy weight on multidisciplinary care<\/a>. It also points patients toward doctors with specialized experience in mesothelioma treatment<\/a>.<\/p>\n \u201cChemo and immunotherapy plus surgery does better, plus radiation potentially does better,\u201d Dr. Velotta says. \u201cYou need everybody on your team on board.\u201d<\/p>\n The panel\u2019s advice on choosing a surgeon was pointed. A surgeon should specialize in mesothelioma specifically.<\/p>\n \u201cIt does not count if you\u2019re a high volume thoracic surgeon, but you don\u2019t do much mesothelioma,\u201d Dr. Velotta clarifies. \u201cWe all agree that\u2019s not a good evaluation of what kind of treatment that patient should get.\u201d<\/p>\n![\"Dr](\"https:\/\/www.newsbeep.com\/ie\/wp-content\/uploads\/2026\/07\/Dr-V.jpg\")
<\/p>\n
![\"open](\"https:\/\/www.asbestos.com\/wp-content\/uploads\/caregivers-brochure-icon.svg\"){kind=icon}
<\/p>\n