A major new consensus document from the Society of Thoracic Surgeons (STS), one of the nation’s leading surgical professional organizations, confirms that pleural mesothelioma remains a serious and complex cancer requiring expert, individualized, multidisciplinary care. The document, authored by 17 leading thoracic surgeons, oncologists, pathologists, and radiation specialists from institutions including Memorial Sloan Kettering, Brigham and Women’s Hospital, Mayo Clinic, and NYU Langone, provides updated guidance on how mesothelioma patients should be diagnosed, staged, and treated.
Here is what this important new publication means for patients and their families.
Getting the Diagnosis Right Matters
The expert panel emphasizes that accurate diagnosis, including the specific subtype of mesothelioma (epithelioid, biphasic, or sarcomatoid), is critical because it directly determines what treatment options are available and what outcomes can be expected. Fluid cytology alone can be insufficient, with a sensitivity of 30–75%. Surgical biopsy is recommended for proper tissue sampling, and the panel stresses that multiple biopsy samples from different locations improve diagnostic accuracy. Patients who receive an inadequate initial biopsy may be misclassified, which can affect both their medical care and their legal case.
Comprehensive Staging Is Essential
Before any treatment decision is made, the STS panel recommends that every patient receive at minimum a CT scan and a PET/CT scan. PET/CT imaging can detect occult metastatic disease that CT alone misses, and it alters management in up to 40% of patients. The panel also recommends invasive staging procedures, including EBUS, mediastinoscopy, and in some cases diagnostic laparoscopy to detect hidden spread of disease. This level of thorough staging is the standard of care.
Surgery Remains an Option for Selected Patients But Must Be Done Right
Despite a controversial 2024 randomized trial (MARS 2) that questioned whether surgery adds benefit, the STS expert panel concluded that surgery can still offer meaningful benefit to carefully selected patients, particularly those with epithelioid histology and locoregional disease, when performed at high-volume centers of excellence with experience in mesothelioma. The panel was critical of the MARS 2 trial’s design, noting its limitations in preoperative staging and the 9% postoperative mortality rate observed, which is higher than what experienced centers routinely achieve.
The preferred surgical approach is now Pleurectomy/Decortication (P/D) or Extended Pleurectomy/Decortication (EPD) — lung-sparing operations — rather than Extrapleural Pneumonectomy (EPP), which removes the entire lung. Data from the STS national database confirm that P/D now accounts for 86% of mesothelioma surgeries performed across the country.
Multimodal Treatment Is the Standard
Surgery alone is not the answer. The panel confirms that systemic therapy (chemotherapy, and increasingly immunotherapy) should accompany surgery (either before or after the operation) as determined by a multidisciplinary tumor board. Emerging data on perioperative immunotherapy using nivolumab with or without ipilimumab shows promise. Radiation therapy, including advanced modalities like IMRT and proton therapy, also plays an important role both in primary treatment and in managing recurrent disease.
Recurrence Must Be Actively Managed
Even after successful surgery, mesothelioma frequently recurs. The panel recommends that isolated recurrences (particularly in the chest wall or pleura) be evaluated for repeat surgical resection or stereotactic body radiation therapy (SBRT), which has shown excellent local control rates with low toxicity in multiple studies. Active management of recurrence, rather than acceptance of progressive disease, can extend survival and quality of life.
What This Means If You Have Been Diagnosed with Mesothelioma
This new consensus document reinforces several important points for patients and families:
- Mesothelioma is caused by asbestos exposure. It is not a disease that arises spontaneously. If you or a loved one has been diagnosed with pleural mesothelioma, the question of how, when, and where asbestos exposure occurred is critically important — both medically and legally.
- The standard of care is demanding. Proper diagnosis, thorough staging, expert surgical evaluation, and multidisciplinary treatment planning are all required. Patients who were exposed to asbestos through their work, the work performed by family members, or through the use of talc-based consumer and personal hygiene products may be entitled to substantial compensation from the companies responsible for that exposure. This compensation can greatly help afford the required treatment and ease financial burdens for loved ones.
At The Lanier Law Firm, our mesothelioma legal team has decades of experience representing victims of asbestos exposure. We understand the medical complexity of these cases, including the pathology, the staging, the surgical options, and the science of how asbestos causes mesothelioma. We work with leading medical experts to build powerful cases on behalf of our clients and their families. — Darron E. Berquist
If you or a loved one has been diagnosed with mesothelioma, contact us today for a free consultation. Time matters, and so does having the right legal team.
Note: The article “Velotta JB, Roden AC, Rice J, Simone CB, Upadhyay B, Sood P, Miller
DL, Ripley RT, Wolf A, Burt BM, Kim SS, Opitz I, Kindler HL, Pass HI, Hayanga JWA, Rusch V,
Bueno R, The Society of Thoracic Surgeons 2026 Expert Consensus on the Multimodal Treatment of Pleural Mesothelioma, The Annals of Thoracic Surgery (2026),” is currently in pre-proof/pre-publication stage and has not yet been published in its final form in the Annals of Thoracic Surgery.