Batna Journal of Medical Sciences
Volume 13, Numéro 4, Pages 306-312
2026-06-10
Reassessing Surgical Strategy After Mars 2: A Focused Critical Review
Authors : Lotfi Hocine .
Abstract
The MARS 2 trial is a landmark phase 3 randomized study comparing (extended) pleurectomy/decortication plus chemotherapy with chemotherapy alone in malignant pleural mesothelioma (MPM). In the final report, the surgical strategy was associated with shorter survival, more serious adverse events, and worse quality-of-life and cost-effectiveness outcomes. These findings are directly relevant to current thoracic oncology practice and should shape how surgery is discussed with patients and multidisciplinary teams. Post-publication critiques, including direct correspondence and subsequent thoracic surgical commentary, have nevertheless raised important external-validity concerns, particularly regarding patient selection, staging intensity, operative extent, and downstream systemic therapy delivery. These concerns do not overturn the trial's core result, but they do affect how broadly the findings should be generalized across surgically assessed mesothelioma populations. This focused review argues that MARS 2 should be interpreted as strong evidence against routine use of extended pleurectomy/decortication in broadly defined operable MPM within the tested pathway. However, it should not be simplified into a universal rejection of multidisciplinary surgical evaluation. The most useful interpretation is therefore both practice-changing and nuanced: stronger evidence-based counseling now, and more precise future trials in carefully staged, highly selected populations.
Keywords
malignant pleural mesothelioma ; MARS 2 ; pleurectomy decortication ; surgery ; multidisciplinary care
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