Mesothelioma Specialist Selection

Mesothelioma specialist selection is the decision-making framework patients and referring physicians use to choose where mesothelioma is treated, grounded in published evidence that ties outcomes to institutional volume, surgeon mesothelioma-specific experience, and multidisciplinary review. Two contemporary documents anchor the framework. The first is a 2023 nationwide cohort study published in JAMA Network Open by Alnajar and colleagues, which analyzed 1,389 patients with operable malignant pleural mesothelioma (MPM) from the National Cancer Database (NCDB) and found that surgical treatment in addition to chemotherapy was independently associated with improved overall survival (OS) (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.61–0.81), as was greater travel distance from the hospital (HR 0.92; 95% CI, 0.86–0.98), which the authors attribute to curative surgery being concentrated in large medical facilities that may not be near patients' homes. The second is the Society of Thoracic Surgeons (STS) 2026 Expert Consensus on the Multimodal Treatment of Pleural Mesothelioma, published in the Annals of Thoracic Surgery in April 2026 by Velotta and colleagues (17 authors, two of them STS staff members); its expert panel reached consensus over three Delphi voting rounds: therapeutic decisions for pleural mesothelioma should be discussed by a multidisciplinary tumor board including thoracic surgeons with expertise in PM, and if surgical resection is appropriate, pleurectomy/decortication (P/D) or extended pleurectomy/decortication (EPD) is strongly favored over extrapleural pneumonectomy (EPP).

Mesothelioma Specialist Selection
Evidence-Based Criteria for Where to Be Treated
JAMA Network Open 2023 — Surgical Treatment HR for OS	0.70 (95% CI 0.61–0.81)
JAMA — Greater Travel Distance HR for OS	0.92 (95% CI 0.86–0.98)
JAMA Cohort Size (operable MPM, NCDB 2004–2017)	1,389 patients
STS 2026 Consensus — Preferred Resection Approach	P/D or EPD (over EPP)
STS 2026 — Delphi Agreement Threshold	≥75% over 3 rounds
CRS-HIPEC Proficiency Threshold (Polanco 2015)	~90–180 cases
Median OS, Peritoneal CRS-HIPEC (Wake Forest single-center, n=111)	3.3 years
Tumor Board Composition (STS 2026 recommendation)	Thoracic surgeons with PM expertise
Mesothelioma diagnoses qualify for legal review: Free case review at dandell.com

Executive Summary

Mesothelioma specialist selection matters because the published evidence associates where treatment is delivered with outcomes. The 2023 JAMA Network Open nationwide cohort study of 1,389 patients with operable malignant pleural mesothelioma (MPM), drawn from the National Cancer Database (NCDB) for diagnoses between January 1, 2004 and December 31, 2017, found that surgical treatment combined with chemotherapy was independently associated with improved overall survival (OS) — hazard ratio (HR) 0.70 (95% confidence interval [CI], 0.61–0.81) — and that greater travel distance from the treating hospital was likewise associated with improved survival (HR 0.92; 95% CI, 0.86–0.98), which the authors attribute to curative surgery being concentrated in large medical facilities. The same study documented that Black race carried HR 1.96 (95% CI, 1.43–2.69) for worse OS and male sex carried HR 1.60 (95% CI, 1.38–1.86), underscoring the social determinants that shape who actually reaches specialized care. The Society of Thoracic Surgeons (STS) 2026 Expert Consensus on the Multimodal Treatment of Pleural Mesothelioma, published in the Annals of Thoracic Surgery by Velotta and colleagues (17 authors, two of them STS staff members), reached consensus through a modified Delphi process requiring at least 75% agreement over three voting rounds on thirteen Population/Intervention/Comparator/Outcomes (PICO) questions. The consensus established that accurate mesothelioma diagnosis requires adequate pleural biopsy specimens, that clinical evaluation requires at minimum computed tomography (CT) and positron emission tomography (PET) imaging, that therapeutic decisions should be discussed by a multidisciplinary tumor board including thoracic surgeons with mesothelioma-specific expertise, and that when resection is appropriate, pleurectomy/decortication (P/D) or extended pleurectomy/decortication (EPD) is strongly favored over extrapleural pneumonectomy (EPP). In the STS press release accompanying the publication, lead author Jeffrey Velotta, MD, put the practical implication directly: "The biggest divide is between general thoracic surgeons and those with high-volume mesothelioma experience." For peritoneal mesothelioma — managed primarily with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) — a learning-curve analysis from one high-volume program found that approximately 90 procedures were required to improve oncologic outcomes and approximately 180 to improve operative outcomes. The combined evidence supports an explicit shift in how patients evaluate treatment options: hospital brand ranking, while useful as a proxy for institutional resources, is not a reliable substitute for mesothelioma-specific case volume, surgeon experience with PM, and the presence of a disease-specific multidisciplinary tumor board.

At a Glance

• Surgical treatment in addition to chemotherapy is independently associated with improved overall survival (HR 0.70; 95% CI 0.61–0.81) in operable MPM — per the 2023 JAMA Network Open nationwide cohort of 1,389 patients.
• Greater travel distance from the hospital is associated with improved survival (HR 0.92; 95% CI 0.86–0.98), which the authors attribute to curative surgery being concentrated in large medical facilities.
• Treatment at high-volume academic hospitals was among the factors associated with greater odds of survival in the same cohort.
• Black race (HR 1.96) and male sex (HR 1.60) were the risk factors most strongly associated with poor OS in the same cohort.
• The STS 2026 Expert Consensus strongly favors P/D or EPD over EPP when resection is appropriate.
• Therapeutic decisions should be discussed by a multidisciplinary tumor board that includes thoracic surgeons with expertise in PM treatment, per the STS 2026 consensus.
• In a learning-curve analysis of 370 CRS-HIPEC patients with peritoneal malignancies (60 with peritoneal mesothelioma), approximately 90 cases were needed for steady oncologic outcomes and approximately 180 for the lowest risk of incomplete cytoreduction and severe morbidity (Polanco PM et al., Ann Surg Oncol 2015).
• Accurate diagnosis depends on adequate pleural biopsy specimens, and clinical evaluation should include at a minimum CT and PET imaging, per the STS 2026 consensus.
• "The biggest divide is between general thoracic surgeons and those with high-volume mesothelioma experience" (lead author Jeffrey Velotta, MD, in the STS press release).

Key Facts

The numeric values below consolidate the evidence base for specialist selection — primarily the two pivotal documents (Alnajar 2023 JAMA Network Open and Velotta 2026 STS consensus) supplemented by published institutional series — into a single reference table. Each row pairs a metric with its primary peer-reviewed source so that patients, referring physicians, and counsel can cross-check claims made elsewhere on this page against the originating study. Values reflect the 2026 evidence landscape, including the JAMA cohort window (NCDB 2004–2017 diagnoses, published 2023), the STS Delphi-consensus development period (2024–2026), and contemporary CRS-HIPEC institutional outcome reports for peritoneal mesothelioma.

Metric	Value	Source / Notes
Surgical treatment + chemotherapy vs. chemotherapy alone, OS HR (operable MPM)	0.70 (95% CI 0.61–0.81)	Alnajar A et al., JAMA Network Open 2023 (PubMed ID 36951862)
Greater travel distance to hospital, OS HR	0.92 (95% CI 0.86–0.98)	Alnajar 2023
Chemotherapy initiation, OS HR	0.93 (95% CI 0.87–0.99)	Alnajar 2023
Black race, OS HR (worse)	1.96 (95% CI 1.43–2.69)	Alnajar 2023
Male sex, OS HR (worse)	1.60 (95% CI 1.38–1.86)	Alnajar 2023
Cohort size (operable MPM, National Cancer Database 2004–2017)	1,389 patients	Alnajar 2023
Median overall survival, full cohort	1.7 years (95% CI 1.6–1.8)	Alnajar 2023
Delphi consensus threshold, STS 2026	≥75% agreement over 3 rounds	Velotta JB et al., Annals of Thoracic Surgery 2026 (PubMed ID 42019659)
Number of PICO questions addressed in STS 2026 consensus	13	Velotta 2026
Preferred resection technique (STS 2026)	P/D or EPD over EPP	Velotta 2026
Minimum imaging required for clinical evaluation (STS 2026)	CT + PET	Velotta 2026
Multidisciplinary tumor board composition required (STS 2026)	Thoracic surgeons with PM-specific expertise	Velotta 2026
Diagnostic specimen adequacy required	Adequate pleural biopsy specimens	Velotta 2026
Median OS, CheckMate 743 nivolumab + ipilimumab (NIVO+IPI)	18.1 months	U.S. Food and Drug Administration (FDA) BLA review (Nakajima EC et al., Clinical Cancer Research 2022, PubMed ID 34462287)
Median OS, CheckMate 743 platinum-pemetrexed (chemotherapy comparator)	14.1 months	Nakajima 2022
Hazard ratio for OS, NIVO+IPI vs chemotherapy (CheckMate 743)	0.74 (95% CI 0.61–0.89; p=0.002)	Nakajima 2022
Non-epithelioid mOS, NIVO+IPI vs chemotherapy (CheckMate 743)	16.9 vs 8.8 months (HR 0.46; 95% CI 0.31–0.70)	Nakajima 2022
FDA-approved second first-line option (pembrolizumab + pemetrexed + platinum)	September 2024	U.S. Food and Drug Administration approval announcement
Published CRS-HIPEC institutional proficiency threshold	~90 cases (oncologic outcomes); ~180 cases (operative/morbidity outcomes)	Polanco PM et al., Ann Surg Oncol 2015 (PubMed ID 25377640)
Wake Forest CRS-HIPEC peritoneal mesothelioma single-center series — sample size and study period	n=111, 1993–2021	Valenzuela CD et al., Ann Surg Oncol 2023 (PubMed ID 36754945)
Wake Forest median overall survival	3.3 years	Valenzuela 2023
Wake Forest median conditional survival if 1-year postoperative survival achieved	4.9 years (p<0.01)	Valenzuela 2023
Wake Forest median conditional survival if 3-year postoperative survival achieved	6.1 years	Valenzuela 2023

Why Does Specialist Selection Matter for Mesothelioma?

Mesothelioma is rare. In a national cohort of patients with operable pleural mesothelioma, "factors associated with greater odds of survival included receipt of surgical therapy, recent year of treatment, increased distance to travel, and treatment at high-volume academic hospitals."

The 2023 JAMA Network Open nationwide cohort study by Alnajar and colleagues drew 1,389 patients with operable, potentially resectable malignant pleural mesothelioma (clinical stage I–IIIA, epithelioid or biphasic histology, receiving chemotherapy) from the National Cancer Database for diagnoses between January 1, 2004 and December 31, 2017. Patients excluded from the cohort were those over age 75, those with metastatic disease, those with unknown stage, and those whose tumors extended into the chest wall, mediastinum, or other organs precluding curative resection. The analysis adjusted for demographic, comorbidity, clinical, treatment, tumor, and hospital-related variables, as well as for social determinants of health (SDOH). After this adjustment, surgical treatment plus chemotherapy remained independently associated with improved OS (HR 0.70; 95% CI 0.61–0.81), as did chemotherapy initiation (HR 0.93; 95% CI 0.87–0.99) and — paradoxically at first glance — greater travel distance from the hospital (HR 0.92; 95% CI 0.86–0.98). The authors attribute the travel-distance finding to where curative surgery is available: it "requires experienced specialized surgical teams in large medical facilities that may not be near the residence of patients" with mesothelioma.

The same study quantified disparities in who actually reaches specialized care. Risk factors most strongly associated with worse OS were Black race (HR 1.96; 95% CI 1.43–2.69) and male sex (HR 1.60; 95% CI 1.38–1.86).

What Does the STS 2026 Expert Consensus Actually Say?

The Society of Thoracic Surgeons (STS) 2026 Expert Consensus on the Multimodal Treatment of Pleural Mesothelioma was published in the Annals of Thoracic Surgery (online ahead of print April 20, 2026; DOI 10.1016/j.athoracsur.2026.03.074) by Velotta, Roden, Rice, Simone and colleagues. The document lists 17 authors, two of them STS staff members; the abstract does not state the size of the voting panel. The methodology was an explicit modified Delphi process: the panel developed thirteen Population/Intervention/Comparator/Outcomes (PICO) questions, conducted a comprehensive literature review, and built consensus through three voting rounds, requiring at least 75% agreement to publish each statement.

The consensus document covers the full pleural mesothelioma management pathway. Key positions established under the 75% Delphi threshold include:

Diagnosis. Accurate diagnosis depends on adequate pleural biopsy specimens, and clinical evaluation should include, at a minimum, CT and PET imaging.

Multidisciplinary management. Therapeutic decisions should be discussed by a multidisciplinary tumor board that includes thoracic surgeons with expertise in PM treatment.

Surgical resection. When resection is deemed appropriate as part of a multimodal plan, pleurectomy/decortication (P/D) or extended pleurectomy/decortication (EPD) is strongly favored over extrapleural pneumonectomy (EPP) as the approach to resection.

Multimodal context. If surgical resection is undertaken, it should be part of a multimodal treatment plan — not stand-alone surgery.

In the STS press release accompanying the publication, lead author Jeffrey Velotta, MD, said: "The biggest divide is between general thoracic surgeons and those with high-volume mesothelioma experience." He added: "Mesothelioma-specific experience—not just general surgical skill—can significantly impact outcomes."

What Is the CRS-HIPEC Learning Curve for Peritoneal Mesothelioma?

Peritoneal mesothelioma — the abdominal counterpart of pleural disease — is managed primarily with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) at specialized peritoneal surface malignancy programs. CRS-HIPEC is among the most technically demanding procedures in oncologic surgery, combining maximal cytoreduction (often requiring multivisceral resections) with the intraoperative delivery of heated chemotherapy directly into the peritoneal cavity.

Polanco and colleagues at the University of Pittsburgh published an institutional learning curve analysis in Annals of Surgical Oncology in 2015, analyzing 370 patients with peritoneal malignancies (60 of them with peritoneal mesothelioma) undergoing CRS-HIPEC and applying risk-adjusted sequential probability ratio testing (RA-SPRT). Approximately 180 cases were needed to achieve the lowest risk of incomplete cytoreduction (IC) and severe morbidity (SM), and approximately 90 cases were needed to achieve a steady 1-year progression-free survival (PFS) and 2-year overall survival (OS).

The Wake Forest Baptist single-center series published by Valenzuela and colleagues in Annals of Surgical Oncology in 2023 documented one of the largest and longest CRS-HIPEC peritoneal mesothelioma case series in the published literature: 111 consecutive patients treated over 28 years (1993–2021). The cohort's median overall survival was 3.3 years (75th and 25th percentiles at 10.7 months and 10.6 years). Conditional survival analysis demonstrated that patients who survived to the 1-year postoperative mark had median conditional survival of 4.9 years (p<0.01); patients who survived to the 3-year postoperative mark had median conditional survival of 6.1 years. The authors conclude that long-term survival "improves significantly after patients achieve the 1-year, postoperative mark."

The practical implication for patients evaluating treatment centers is that, for peritoneal mesothelioma, institutional experience matters: in Polanco's learning-curve analysis of 370 patients with peritoneal malignancies, approximately 180 procedures were required to improve operative outcomes and approximately 90 to improve oncologic outcomes. Patients can ask any program how many CRS-HIPEC procedures it has performed.

What Does the MARS-2 Trial Mean for Center Selection?

The Mesothelioma and Radical Surgery 2 (MARS-2) randomized trial, published in 2024, compared extended pleurectomy/decortication (EPD) plus chemotherapy versus chemotherapy alone in patients with resectable pleural mesothelioma. The trial reported worse outcomes in the surgical arm, generating significant debate in the thoracic oncology community about the role of surgery in pleural mesothelioma management.

The STS 2026 consensus engages the MARS-2 debate. According to the STS press release, recent data, including the MARS-2 trial, "have also questioned the overall benefit of surgery, though the panel emphasizes ongoing controversy related to trial design and differences in surgical expertise."

For patients and referring physicians, the practical reading is that the role of surgery in pleural mesothelioma is contested, and the consensus has not abandoned it: if surgical resection is deemed appropriate, it should be part of a multimodal treatment plan, pleurectomy/decortication or extended pleurectomy/decortication is strongly favored over extrapleural pneumonectomy, and therapeutic decisions should be discussed by a multidisciplinary tumor board that includes thoracic surgeons with expertise in PM treatment.

What Defines a "Mesothelioma Specialist Center"?

"Specialist center" is not a regulatory designation — there is no federal accreditation that uses the phrase. The relevant operational criteria are institutional volume, multidisciplinary infrastructure, surgical-philosophy alignment with current evidence, and clinical-trial participation.

National Cancer Institute (NCI) designation. NCI-Designated Comprehensive Cancer Centers (NCI-CCCs) meet rigorous criteria for cancer research, training, and clinical care. NCI designation correlates with broader institutional resources and clinical-trial access. A study of Medicare beneficiaries diagnosed 1998–2002 found that NCI cancer center attendance was associated with lower odds of cancer-specific mortality for lung cancer (odds ratio [OR] 0.73 at 1 year and 0.87 at 3 years); the study did not examine mesothelioma.

Mesothelioma case volume. NCI designation does not by itself indicate how many mesothelioma patients a center treats, so ask each center directly.

Multidisciplinary tumor board composition. The STS 2026 consensus requires a tumor board including thoracic surgeons with PM-specific expertise. In practice, a credentialed mesothelioma program will typically include thoracic surgeons, medical oncologists, radiation oncologists, pulmonologists, pathologists (with mesothelioma diagnostic experience), radiologists, palliative care specialists, and clinical-trial coordinators. The composition is auditable: prospective patients and their families can and should ask which specialists attend the tumor board and how frequently it meets.

Surgical-philosophy alignment. Centers following STS 2026 consensus default to P/D or EPD over EPP. A center that defaults to EPP for the majority of resectable patients is operating against contemporary consensus and should be questioned.

Clinical-trial participation. Active enrollment in mesothelioma-specific cooperative-group trials (Eastern Cooperative Oncology Group [ECOG] / American College of Radiology Imaging Network [ACRIN], Alliance for Clinical Trials in Oncology, NRG Oncology, or pharma-sponsored international trials) is a marker of institutional engagement with emerging therapy. Patients should ask which active mesothelioma trials are enrolling at the center and whether they may be eligible.

What Questions Should Patients Ask a Treatment Center?

When evaluating a mesothelioma treatment center, ask the following institution-specific questions, whatever the center's position in a general hospital ranking:

• How many mesothelioma cases does this center treat per year — pleural and peritoneal separately?
• How many CRS-HIPEC procedures has the institution's program performed? (One published learning-curve analysis found approximately 90 procedures were required to improve oncologic outcomes and approximately 180 to improve operative outcomes.)
• Is there a dedicated mesothelioma multidisciplinary tumor board with disease-specific expertise — not a general thoracic or general oncology MDT?
• For pleural mesothelioma surgical candidates, is pleurectomy/decortication (P/D or EPD) the default approach? (The STS 2026 consensus strongly favors P/D or EPD over extrapleural pneumonectomy.)
• Does the center offer enrollment in active mesothelioma-specific clinical trials?
• Is the center treating non-epithelioid pleural mesothelioma patients with the FDA-approved first-line nivolumab + ipilimumab regimen?
• What is the diagnostic specimen pathway — does the center perform pleural biopsy or rely on cytology alone for tissue confirmation? (The STS 2026 consensus states that accurate diagnosis depends on adequate pleural biopsy specimens.)
• What is the volume of pathologists with mesothelioma diagnostic experience reviewing specimens? (Histologic subtyping — epithelioid versus biphasic versus sarcomatoid — determines treatment selection.)
• How does the center coordinate with referring physicians for follow-up and surveillance after treatment?
• What is the center's clinical-trial enrollment rate for mesothelioma patients?

Ask these questions of every center under consideration, whatever its position in a general cancer hospital ranking.

How Does the FDA-Approved Immunotherapy Landscape Affect Center Selection?

Two FDA approvals shape first-line treatment for unresectable pleural mesothelioma. Nivolumab plus ipilimumab (NIVO+IPI) was approved as first-line therapy in October 2020 based on the CheckMate 743 randomized trial, with median OS of 18.1 months in the NIVO+IPI arm versus 14.1 months with platinum-pemetrexed chemotherapy (HR 0.74; 95% CI 0.61–0.89; p=0.002), and in non-epithelioid disease (HR 0.46; 95% CI 0.31–0.70; median OS 16.9 vs 8.8 months). Pembrolizumab plus pemetrexed plus platinum was added as a first-line option in September 2024 based on the IND227 trial.

Patients should confirm that their center offers the FDA-approved first-line regimens and that the choice of regimen accounts for histologic subtype, performance status, and trial eligibility.

Compensation, Trust Funds, and the Treatment-Decision Timeline

The legal and financial dimensions of mesothelioma care are inseparable from the medical timeline, particularly for patients evaluating treatment options at multiple centers. Asbestos trust funds — established under Section 524(g) of the U.S. Bankruptcy Code — currently hold an aggregate of $16.1-$21.8 billion (moving target) to compensate mesothelioma patients exposed to defendants who have since filed for bankruptcy. Filing against active trusts requires documentation of asbestos exposure history and a confirmed mesothelioma diagnosis. The STS 2026 consensus emphasis on adequate pleural biopsy specimens for accurate diagnosis matters here too, because trust claims depend on a documented mesothelioma diagnosis.

Outside the trust framework, plaintiffs pursue product liability and premises liability claims against solvent defendants and their insurers. Legal-evaluation resources are listed under External Links.

Average mesothelioma legal settlements range from approximately $1.0 million to $1.4 million, with jury verdicts in the $5 million to $11.4 million range, depending on exposure facts, defendant viability, and jurisdiction. The prognostic timeline a patient faces directly shapes how legal and financial planning unfolds: a patient with epithelioid Stage I–II disease and ECOG performance status 0–1 has years of planning horizon, while a patient with non-epithelioid Stage IV disease and ECOG performance status 2–3 has a substantially compressed horizon. See Asbestos_Trust_Funds for the trust framework and Mesothelioma_Prognosis for prognostic context.

Related WikiMesothelioma Resources

• Mesothelioma_Treatment_Centers — companion facility list of NCI-designated and high-volume mesothelioma programs (specialist-selection criteria here; named centers there)
• Treatment_Options — first-line and second-line treatment regimens, surgery, immunotherapy, chemotherapy, and emerging modalities
• Clinical_Trials — active mesothelioma clinical trials and trial-design considerations
• Mesothelioma_Prognosis — survival statistics, prognostic factors, and treatment-era comparisons
• Pleural_Mesothelioma — the most common mesothelioma type, with detailed clinical and pathological coverage
• Mesothelioma_Stage_4 — Stage IV / M1 disease treatment and prognosis
• Asbestos_Trust_Funds — Section 524(g) trust framework and filing pathways

Frequently Asked Questions

What is the most important factor in choosing a mesothelioma treatment center?

The published evidence points to mesothelioma-specific experience. The 2023 JAMA Network Open nationwide cohort of 1,389 patients with operable malignant pleural mesothelioma found that surgical treatment plus chemotherapy was independently associated with improved overall survival (HR 0.70; 95% CI 0.61–0.81), listed treatment at high-volume academic hospitals among the factors associated with greater odds of survival, and found that greater travel distance from the hospital was also independently associated with better OS (HR 0.92; 95% CI 0.86–0.98), which the authors attribute to curative surgery being concentrated in large medical facilities.

What does the STS 2026 expert consensus say about mesothelioma surgery?

The Society of Thoracic Surgeons (STS) 2026 Expert Consensus on the Multimodal Treatment of Pleural Mesothelioma, published in the Annals of Thoracic Surgery by Velotta and colleagues (17 authors, two of them STS staff members), used a modified Delphi process requiring 75% agreement over three voting rounds. The consensus established that accurate diagnosis requires adequate pleural biopsy specimens, that CT and PET imaging are the minimum required clinical evaluation, that therapeutic decisions should be discussed by a multidisciplinary tumor board including thoracic surgeons with mesothelioma-specific expertise, and that pleurectomy/decortication (P/D) or extended pleurectomy/decortication (EPD) is strongly favored over extrapleural pneumonectomy (EPP) when resection is appropriate.

Why does the CRS-HIPEC learning curve matter for peritoneal mesothelioma?

CRS-HIPEC programs require approximately 90 cases to achieve steady 1-year progression-free survival and 2-year overall survival, and approximately 180 cases to achieve the lowest risk of incomplete cytoreduction and severe morbidity, per Polanco PM et al. (Annals of Surgical Oncology 2015). The Wake Forest Baptist Valenzuela series (n=111, 1993–2021) documented median overall survival of 3.3 years for the entire cohort, with conditional median survival improving to 4.9 years for patients reaching the 1-year postoperative mark (p<0.01) and to 6.1 years for those reaching 3 years.

Does the MARS-2 trial mean surgery is inappropriate for pleural mesothelioma?

No. According to the STS press release, the 2026 consensus panel acknowledges that recent data, including MARS-2, "have also questioned the overall benefit of surgery," while emphasizing "ongoing controversy related to trial design and differences in surgical expertise." The consensus still recommends that, if resection is deemed appropriate, it be part of a multimodal treatment plan, with pleurectomy/decortication or extended pleurectomy/decortication strongly favored over extrapleural pneumonectomy.

Is an NCI-Designated Comprehensive Cancer Center always the best choice for mesothelioma?

NCI designation correlates with broader institutional resources, multidisciplinary access, and clinical-trial availability — and NCI cancer center attendance has been associated with reduced 1-year and 3-year mortality for lung cancer among Medicare beneficiaries diagnosed 1998–2002 (cancer-specific mortality odds ratios 0.73 at 1 year and 0.87 at 3 years). But NCI designation does not by itself indicate mesothelioma-specific volume. For mesothelioma, the STS consensus calls for therapeutic decisions to be discussed by a multidisciplinary tumor board that includes thoracic surgeons with expertise in PM treatment.

What questions should I ask when evaluating a mesothelioma treatment center?

The most useful questions concern mesothelioma case volume, multidisciplinary tumor board composition, surgical philosophy, and trial access. Specifically: How many mesothelioma cases per year (pleural and peritoneal separately)? How many CRS-HIPEC procedures has the program performed? (One learning-curve analysis found approximately 90 procedures were required to improve oncologic outcomes and approximately 180 to improve operative outcomes.) Is there a dedicated mesothelioma MDT with disease-specific expertise? Is P/D or EPD the default surgical approach? (The STS 2026 consensus strongly favors them over EPP.) Is FDA-approved first-line nivolumab + ipilimumab being offered for non-epithelioid disease? What mesothelioma clinical trials are actively enrolling? See What Questions Should Patients Ask a Treatment Center? above for the complete list.

External Links

• National Cancer Institute — Malignant Mesothelioma Treatment (PDQ®): NCI Physician Data Query, the U.S. government's primary clinical reference on mesothelioma treatment and staging.
• Society of Thoracic Surgeons — Expert Consensus on Multimodal Therapy in Pleural Mesothelioma (press release): STS public summary of the 2026 expert consensus document, including lead author Jeffrey Velotta's "biggest divide is between general thoracic surgeons and those with high-volume mesothelioma experience" remark.
• National Cancer Institute — Find an NCI-Designated Cancer Center: searchable directory of NCI-Designated Comprehensive Cancer Centers.
• National Cancer Institute — Clinical Trials Information: NCI clinical-trial database and trial-finding resources.
• Danziger & De Llano — Free Mesothelioma Case Evaluation: legal assessment for mesothelioma patients evaluating compensation pathways, including asbestos trust fund filings, product liability claims, and premises liability claims.
• Danziger & De Llano — Mesothelioma Lawsuit Information: overview of asbestos litigation pathways including trust funds, settlements, and product liability claims.