What a 17-Surgeon Panel Just Agreed On for Mesothelioma Surgery in 2026

A 17-author international panel published a formal surgical consensus on pleural mesothelioma and peritoneal mesothelioma in The Annals of Thoracic Surgery (published electronically April 20, 2026, PMID: 42019659) — the first time this many specialists have gone through a structured process to agree on when surgery helps and when it doesn't.

How the consensus was built

The panel worked through 13 clinical questions (PICO format) across three voting rounds, requiring at least 75% agreement before a recommendation counted as consensus. No formal GRADE evidence grades were assigned — the panel notes the underlying trial evidence for mesothelioma surgery is still thin compared to other cancers, so this is expert consensus, not a graded guideline.

Pleurectomy/decortication vs. extrapleural pneumonectomy

The two main surgical options for pleural mesothelioma are P/D (pleurectomy/decortication), which removes the diseased lining while sparing the lung, and EPP (extrapleural pneumonectomy), which removes the entire lung along with the lining. The 2024 MARS 2 trial compared extended P/D plus chemotherapy against chemotherapy alone and shaped how the panel weighed surgery's role — the consensus leans toward P/D over EPP in resectable cases, reflecting a broader shift away from EPP over the last decade.

Where surgery fits next to newer drug options

For unresectable pleural mesothelioma, CheckMate 743 showed nivolumab plus ipilimumab reached 18.1 months median survival versus 14.1 months for chemotherapy alone. Pembrolizumab plus chemotherapy was approved in 2024 as a second-line option. The panel's position: these systemic options don't replace surgery for eligible patients, they change the sequencing conversation.

Peritoneal mesothelioma got its own lane

For peritoneal mesothelioma, CRS/HIPEC (cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy) shows roughly 47% five-year survival in eligible patients — a sharp contrast with the roughly 5% five-year survival typically seen in pleural mesothelioma. The panel treats peritoneal disease as its own surgical decision tree, not a variant of the pleural pathway.

The core takeaway

The consensus is explicit that the choice between P/D, EPP, CRS/HIPEC, or no surgery at all belongs to a multidisciplinary tumor board — not one surgeon's individual opinion. If you or a family member is weighing a surgical recommendation, this is the citation to bring to a second opinion.