Mesothelioma Surgery Post MARS 2 Trial: Survivor & Specialist Voices
Written by Karen Selby, RN and Travis Rodgers | Edited by Amy Edel
The bellwether MARS 2 trial shifts the conversation on surgery for pleural mesothelioma. Our exclusive surveys and interviews share perspectives from survivors and specialists on its impact on care, policy and treatment paths.
Cancer Centers Reassess Mesothelioma Surgery Approach After MARS 2
Doctors at cancer centers across the U.S. have long considered surgery within a multimodal, or a combination of treatment approaches, the gold standard of care for pleural mesothelioma. But a 2024 U.K. study, the MARS 2 trial, has challenged how cancer centers approach surgery and advise their teams on how to build care plans for pleural mesothelioma patients.
The MARS 2 randomized trial involved more than 300 participants and compared outcomes between a group receiving chemotherapy alone and a group receiving chemo plus extended pleurectomy and decortication surgery. The results indicated the group receiving only chemo had longer median survival than the group receiving chemo combined with surgery.
To better understand the scope of the impact the MARS 2 trial is having on mesothelioma treatment in cancer centers in the U.S., The Mesothelioma Center at Asbestos.com conducted its own exclusive survey of mesothelioma specialists. Participants confirmed many institutions are revising multidisciplinary team protocols. In fact, 89% of surgeons and 81% of non‑surgical specialists reported the MARS 2 trial influenced their organization’s surgical approach, according to our survey.
To gain deeper insight into how the MARS 2 trial is influencing leading pleural mesothelioma experts, we hosted in-person discussions at our headquarters with renowned specialists. We also conducted in-person interviews with survivors who personally underwent surgery and fielded a proprietary patient survey.
Multidisciplinary Perspectives on Mesothelioma Care After MARS 2
For many mesothelioma experts, MARS 2 highlights the need for individualized patient evaluation. Oncologist Dr. Hedy Lee Kindler, who directs the Mesothelioma Program at University of Chicago Medicine, tells us a multidisciplinary approach is key to giving each person the best possible treatment.
One of the authors of the 2025 American Society of Clinical Oncology guidelines for pleural mesothelioma treatment, Dr. Kindler co-led our recent webinar, “How Doctors Personalize Mesothelioma Treatment.” She noted, “You really don’t want just one person’s opinion. You really want that team approach that can individualize treatment for a patient based specifically on their situation.”
Dr. Kindler added, “Even after many years of being an experienced mesothelioma physician, I still rely upon my radiologist to show me some of the subtleties. I rely upon my pathologist to discuss some of the subtleties with the pathology.”
In response to the MARS 2 trial, specialists tell us they’ve refined their multidisciplinary approaches, adding more case review meetings, expanding palliative care’s role in planning and improving communication between surgeons, oncologists and nursing staff. This doesn’t mean specialists believe mesothelioma surgery, or even specifically extended P/D that was part of MARS 2, doesn’t still play a part in mesothelioma care.
Our survey shows 69% of nonsurgical mesothelioma specialists believe extended P/D has clinical value for certain patients. While 65% of these specialists agreed and 39% somewhat agreed with the MARS 2 finding that surgery didn’t significantly improve overall survival, the emphasis is on more carefully weighing the needs of each individual. One nonsurgical respondent told us surgery “helps with remission rates.” Another noted, “You should always give the patient options. What works for one patient may not work for another.”
MARS 2 Through the Eyes of Mesothelioma Surgeons
The MARS 2 trial sparked strong reactions among mesothelioma surgeons. Many said the study included patients with advanced disease and tumor types less likely to benefit from extended pleurectomy and decortication. They believe this broader inclusion affected the reported lack of survival benefit.
For many surgeons, MARS 2 reinforces the importance of patient selection and multidisciplinary evaluation in guiding treatment decisions. The results highlight the need for multidisciplinary evaluation to match the right patient with the right treatment at the right time.
Trends in Surgical Approaches and Recommendations After MARS 2
In our survey, 14.3% of cardiothoracic surgeons report they now recommend surgery less often, and 71.4% have become more selective. One-third of surgeons said the trial greatly influenced their organization’s surgical approach. Another third said it moderately influenced their approach. These responses show caution and adaptability as centers apply the findings in practice.
While most respondents agreed with the MARS 2 trial findings, one surgical oncologist noted in their responses they still see the value in recommending surgery and would “like to see a richer history of trial results.” When asked the most compelling reason to continue to offer patients surgery, surgeons agreed they’ve seen the benefits of surgery firsthand with their patients. Several respondents noted, “It works.”
Among all respondents, surgical and nonsurgical responses combined, 23% listed “patient preference” as one of their top reasons for referring someone for surgery. About 37% of respondents said a patient’s “functional/physical status” was a top factor.
What the MARS 2 Findings Mean for Surgeons in Practice
Our survey data shows 66% of surgeons and nonsurgical respondents now feel more selective about recommending surgery. But surgeons tell us they see the MARS 2 trial as a call to refine, not reject, surgical care for pleural mesothelioma.
Surgeons also tell us the MARS 2 trial included many patients who wouldn’t meet stricter selection criteria, such as those with advanced disease or aggressive tumor types. This shapes their view that the reported outcomes don’t apply to all surgical candidates.
Dr. Jacques Fontaine, director of the Mesothelioma Research and Treatment Center at Moffitt Cancer Center in Tampa, joined us for in-person conversations about mesothelioma surgery. He told us several doctors are working to create a consortium to study the benefits of surgery for specific patients after the MARS 2 trial. He told us surgery isn’t right for every mesothelioma patient, but it can offer great benefits to the right person.
“You need to look at that specific patient, and some patients do benefit from aggressive surgery,” Dr. Fontaine told us. “Who are those patients? Those are usually patients who have epithelial type mesothelioma with early-stage disease that hasn’t progressed to the lymph nodes or outside the chest. Patients who are rather young and fit and have a low burden of disease. And, most importantly, the patients must want surgery.”
Dr. Jeffrey Velotta, the surgical director of the Kaiser Permanente Northern California Mesothelioma program, also participated in our in-person conversations and agreed with Dr. Fontaine. Dr. Velotta is also leading the Society of Thoracic Surgeons Expert Consensus Statement on the Recommendations for the Mulitmodal Treatment of Pleural Mesothelioma that will be published prior to the upcoming STS Annual Meeting in January 2026. He told us the findings from the MARS 2 trial may influence how he and other surgeons design treatment plans for their patients. Dr. Velotta said this can include making eligibility decisions based on a patient’s specific mesothelioma type or stage of cancer progression.
“Maybe we could be slightly more selective. Make sure that they have the epithelioid type,” Dr. Velotta noted. “Make sure that they have an earlier stage. Make sure that you really stage the patient beforehand, so you’re not taking late-stage patients to surgery. And make sure that they’re seen by a multidisciplinary group that specializes in mesothelioma.”
Voices and Experiences of Mesothelioma Survivors After Surgery
In our exclusive patient-focused survey, mesothelioma survivors who had surgery shared their experiences with us. Among respondents, 70% of mesothelioma patients describe their surgery experience positively. Only 12% felt negatively. This matches the experiences of patients with other types of cancer, showing shared hopes and challenges.
Surgical patients shared that surgery offered them meaningful quality-of-life benefits. Three months after treatment, 76% of mesothelioma patients reported a better quality of life. And 79% said surgery helped their overall condition, while only 15% said their condition didn’t improve.
Our survey results also underscore the consistent importance of early diagnosis in determining eligibility for surgery. Most patients offered surgery were in early stages, with 85% of patients in stages 1 and 2 compared to 17% of patients in stages 3 and 4.
| Response | Percent of responses |
|---|---|
| Yes | 79% |
| No | 15% |
| Unsure | 6% |
Survivor Perspectives on Their Surgery and Long-Term Outcomes
Many mesothelioma survivors and caregivers shared insights about the impact of surgery on their health and daily lives. Their firsthand perspective offers valuable insight into how surgery shapes long-term prognosis.
Among those we surveyed, 73% of mesothelioma patients said they would recommend surgery to others facing the same choice. Patient sentiment is mostly optimistic, with 70% of surgical patients rating their overall experience as positive. These results show that for many survivors, surgery isn’t just a medical step but also a source of hope for their future.
| Response | Percent of responses |
|---|---|
| Positive | 70% |
| Neutral | 18% |
| Negative | 12% |
How Survivors Describe the Impact of Surgery for Mesothelioma
Mesothelioma survivors shared their personal experiences with surgery and how it’s impacted their lives with us in a series of in-person conversations. They discussed the challenges and benefits, and the importance of advocating for themselves on their treatment journeys.
Each survivor explains that despite the risks of surgery, sometimes from aggressive surgeries like the extrapleural pneumonectomy, they were willing to accept the challenge and trust in their surgeons. They say surgery has helped them live beyond their life expectancies and surpassed their prognoses.
Linda’s Story
Linda Hooper tells us she was diagnosed with pleural mesothelioma in February 2025. She had P/D surgery 2 months later. Linda advocated for herself and pushed to have surgery after it was delayed twice. She says deciding to have surgery was easy for her.
After connecting with her thoracic surgeon and mesothelioma specialist, Dr. Velotta explained the procedure she would undergo. She tells us that while understanding the challenges involved with mesothelioma surgery, she still firmly believed it was right for her. His explanation didn’t change her mind.
“I didn’t have reservations, even though I knew it was going to be a long recovery,” Linda tells us. “Dr. Velotta told me I was going to be in a lot of pain. The pain’s still there, not as much of course. It gets better. But I didn’t have reservations about the surgery. Once I saw the cancer on my lungs, it’s like: I’m going to do what I need to do to get rid of it. The surgery to me was my only option.”
Linda was in the hospital for 12 days after her procedure. We talked with her 12 weeks after surgery. Linda shares her decision to have surgery is something she’d do all over again.
“Yes, knowing what I know now, I would absolutely do it again because I wanted the cancer out of me,” Linda says. “Dr. Velotta said he went in and got it all. My follow-up treatments are going to be to keep it at bay. Yes, I would go through this again because it’s what I need to do in order to survive as long as I can.”
Linda gave thoughtful advice when asked what she would say to someone who was told they need a similar surgery. She emphasized the importance of commitment and seeing the process through.
“I would say if you can handle it, do it,” she reflects. “But you have to be sure that you’re going to follow through on what needs to be done afterward. You need to say you’re going to walk, you’re going to eat, you’re going to do the things that you have to do to get better. You have to follow through, whether it’s with physical therapy or having somebody encourage you to get up and walk, or you have to be self-disciplined.”
Michael’s Story
Ten-year pleural mesothelioma survivor Michael Cole also shared his story in our in-person conversations. He had an extrapleural pneumonectomy after his pleural mesothelioma diagnosis in 2015. This aggressive surgery removed his entire lung and the surrounding cancer tissue. He also had several rounds of chemo after surgery.
Two years later, the cancer returned. Instead of another surgery, he chose multimodal therapy with immunotherapy and radiation. Michael says he wasn’t really worried about the surgery at the time; he was just eager to get rid of the cancer.
Michael shares, “I’m not sure that I was really prepared for how difficult that surgery was, even though the doctor told me that it was as big as any surgery that a person could possibly have.” But he says, “I was willing to accept that.”
“‘Let’s just get it done,’ was my attitude,” Michael recalls. “I think that’s the right attitude to have about it. The surgery was difficult, there’s no doubt about it. It was difficult to recover from, but it wasn’t insurmountable.”
He says his aggressive surgery and recovery time was challenging, but he also says he feels blessed to have had these 10 years with his wife, who he married shortly before his diagnosis. Today, Michael is a regular contributor for The Mesothelioma Center, writing blogs about his personal experiences and participating in webinars to help fellow mesothelioma survivors.
Where the MARS 2 Conversation Goes From Here
The MARS 2 trial has ended, but how it’s affecting the conversation about surgery for pleural mesothelioma is just getting started. While specialists and survivors share their personal experiences with mesothelioma surgery, surgeons also express concern about how people outside the medical community interpret the MARS 2 trial’s conclusions.
Some surgeons tell us public discussions may sometimes overstate or oversimplify the findings. This could discourage patients who might benefit from surgery. For surgeons, clear communication and shared decision-making are key to balancing risks and benefits when planning treatment.
One mesothelioma caregiver of a mesothelioma patient emphasized the importance of communication in our survey: “Compassionate care and clear communication made the treatment experience feel more manageable.” How specialists and survivors discuss surgery for pleural mesothelioma can make a significant difference in choices and overall feelings about the process.
About half, 49.7%, of nonsurgical specialists believe the MARS 2 trial findings may not always be fully conveyed or interpreted accurately in public discussions. Many said this makes it harder for patients to fully understand their surgical options.
Looking ahead, new research, clinical practice and firsthand experience will shape the future of mesothelioma care. Listening to experts, survivors and families remains vital to ensure everyone on a mesothelioma journey gets clear information and a care plan that fits their needs and priorities.
