This study of a contemporary national database compared postresection outcomes of cN0/pN0, cN0/pN+, and cN+ mesothelioma. Relative to pN0, pN+ was associated with 51% higher hazard of mortality; survival of cN0/pN+ and cN+ were similar. The number of involved nodes (not nodal tumor, node, metastasis classification results) was associated with survival. Routine pathologic nodal staging should be done for potentially resectable mesothelioma.