Research progress on mediastinal lymph node dissection with preservation of the posterior pulmonary vagus nerve branches_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHAO Weipeng , SUN Jian ,  GUO Hongbo

Department of Thoracic Surgical WardⅡ, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, P. R. China;

Corresponding author：

GUO Hongbo, Email: guomutong@126.com

Keywords：

Vagus nerve; posterior pulmonary plexus; lung cancer; mediastinal lymph node dissection; XX

DOI：

10.7507/1007-4848.202505008

Video：

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The mediastinal lymph node dissection (MLND) with preservation of the posterior pulmonary vagus nerve branches is an emerging function-preserving strategy in lung cancer surgery, its application in clinical practice has received increasing attention. However, the available evidence-based medical evidence for this approach is still insufficient. This review aims to systematically review and summarize the current literature on MLND with preservation of the posterior pulmonary vagus nerve branches in lung cancer surgery, covering its definition, anatomical and physiological basis, surgical technical points, oncological outcomes, postoperative complications and functional benefits, indications and contraindications, as well as the current consensus, controversies and future development directions. This review provides references for clinical practice and future research.

1.	Zimmermann J, Walter J, Pfeiffer V, et al. Propensity score matched comparison of lymph node upstaging in early-stage lung cancer: open versus minimally invasive surgery with standardized lymphadenectomy. J Cardiothorac Surg, 2025, 20(1): 1-12.
2.	Huang W, Yang J, Chen H, et al. Preservation of the pulmonary branches of the vagus nerve during three-dimensional thoracoscopic radical resection of lung cancer: a retrospective study. BMC Surg, 2024, 24(1): 49.
3.	Tracey KJ. The inflammatory reflex. Nature, 2002, 420(6917): 853-859.
4.	Matthijs K, Michiel V, Van dHJG, et al. Effects of vagus nerve stimulation and vagotomy on systemic and pulmonary inflammation in a two-hit model in rats. PLoS One, 2012, 7(4): e34431.
5.	Chen Q, Li W, Cai N, et al. Comparison of postoperative complications in mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: protocol for a systematic review and meta-analysis. 2024, 19(2): e0298368.
6.	Maniwa T, Okami J, Miyoshi T, et al. Lymph node dissection in small peripheral lung cancer: supplemental analysis of JCOG0802/WJOG4607L. J Thorac Cardiovasc Surg, 2024, 168(3): 674-683. e1.
7.	Vaporciyan A. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2014, 141(3): 662-670.
8.	Liu X, Chen Z, Zhang S. Application of vagus nerve branch preservation in thoracoscopic surgery for early-stage lung cancer. Biomed Res Int, 2022: 5143383.
9.	Bhojani P, Vasani R. Neuroanatomy, cranial nerve 10, vagus nerve (CN X). In: StatPearls. 2022.
10.	Weijs TJ, Ruurda JP, Luyer MDP, et al. Preserving the pulmonary vagus nerve branches during thoracoscopic esophagectomy. Surg Endosc, 2016, 30(9): 3816-3822.
11.	Wang J, Li J, Liu G, et al. Nerves of the mediastinum. Thorac Surg Clin, 2011, 21(2): 239-249.
12.	Weijs TJ, Ruurda JP, Luyer MDP, et al. Topography and extent of pulmonary vagus nerve supply with respect to transthoracic oesophagectomy. J Anat, 2015, 227(4): 431-439.
13.	Mazzone SB, Canning BJ. Autonomic neural control of the airways. Handb Clin Neurol, 2013, 117: 215-228.
14.	Gu S, Wang W, Wang X, et al. Effects of preserving the pulmonary vagus nerve branches on cough after pneumonectomy during video-assisted thoracic surgery. Front Oncol, 2022, 12: 837413.
15.	Li S, Qi D, Li JN, et al. Vagus nerve stimulation enhances the cholinergic anti-inflammatory pathway to reduce lung injury in acute respiratory distress syndrome via STAT3. Cell Death Discov, 2021, 7(1): 63-72.
16.	Shuyan L, Xiaoya, et al. Low level non-invasive vagus nerve stimulation: a novel feasible therapeutic approach for atrial fibrillation. Int J Cardiol, 2015, 182: 189-190.
17.	Demeester SR. Vagal-sparing esophagectomy: is it a useful addition? Ann Thorac Surg, 2010, 89(6): S2156-S2158.
18.	Song XM, Li JG, Wang YL, et al. Effect of vagus nerve stimulation on thermal injury in rats. Burns, 2010, 36(1): 75-81.
19.	Steven K, And, et al. Mediastinal lymph node dissection improves survival in patients with stages Ⅱand ⅢA non-small cell lung cancer. Ann Thorac Surg, 2000, 70(2): 358-365.
20.	Wu Y. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
21.	Izbicki JR, Passlick B, Pantel K, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg, 1998, 227(1): 138-144.
22.	Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage ⅠA lung cancer. World J Surg, 2000, 24(1): 27-31.

1. Zimmermann J, Walter J, Pfeiffer V, et al. Propensity score matched comparison of lymph node upstaging in early-stage lung cancer: open versus minimally invasive surgery with standardized lymphadenectomy. J Cardiothorac Surg, 2025, 20(1): 1-12.
2. Huang W, Yang J, Chen H, et al. Preservation of the pulmonary branches of the vagus nerve during three-dimensional thoracoscopic radical resection of lung cancer: a retrospective study. BMC Surg, 2024, 24(1): 49.
3. Tracey KJ. The inflammatory reflex. Nature, 2002, 420(6917): 853-859.
4. Matthijs K, Michiel V, Van dHJG, et al. Effects of vagus nerve stimulation and vagotomy on systemic and pulmonary inflammation in a two-hit model in rats. PLoS One, 2012, 7(4): e34431.
5. Chen Q, Li W, Cai N, et al. Comparison of postoperative complications in mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: protocol for a systematic review and meta-analysis. 2024, 19(2): e0298368.
6. Maniwa T, Okami J, Miyoshi T, et al. Lymph node dissection in small peripheral lung cancer: supplemental analysis of JCOG0802/WJOG4607L. J Thorac Cardiovasc Surg, 2024, 168(3): 674-683. e1.
7. Vaporciyan A. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2014, 141(3): 662-670.
8. Liu X, Chen Z, Zhang S. Application of vagus nerve branch preservation in thoracoscopic surgery for early-stage lung cancer. Biomed Res Int, 2022: 5143383.
9. Bhojani P, Vasani R. Neuroanatomy, cranial nerve 10, vagus nerve (CN X). In: StatPearls. 2022.
10. Weijs TJ, Ruurda JP, Luyer MDP, et al. Preserving the pulmonary vagus nerve branches during thoracoscopic esophagectomy. Surg Endosc, 2016, 30(9): 3816-3822.
11. Wang J, Li J, Liu G, et al. Nerves of the mediastinum. Thorac Surg Clin, 2011, 21(2): 239-249.
12. Weijs TJ, Ruurda JP, Luyer MDP, et al. Topography and extent of pulmonary vagus nerve supply with respect to transthoracic oesophagectomy. J Anat, 2015, 227(4): 431-439.
13. Mazzone SB, Canning BJ. Autonomic neural control of the airways. Handb Clin Neurol, 2013, 117: 215-228.
14. Gu S, Wang W, Wang X, et al. Effects of preserving the pulmonary vagus nerve branches on cough after pneumonectomy during video-assisted thoracic surgery. Front Oncol, 2022, 12: 837413.
15. Li S, Qi D, Li JN, et al. Vagus nerve stimulation enhances the cholinergic anti-inflammatory pathway to reduce lung injury in acute respiratory distress syndrome via STAT3. Cell Death Discov, 2021, 7(1): 63-72.
16. Shuyan L, Xiaoya, et al. Low level non-invasive vagus nerve stimulation: a novel feasible therapeutic approach for atrial fibrillation. Int J Cardiol, 2015, 182: 189-190.
17. Demeester SR. Vagal-sparing esophagectomy: is it a useful addition? Ann Thorac Surg, 2010, 89(6): S2156-S2158.
18. Song XM, Li JG, Wang YL, et al. Effect of vagus nerve stimulation on thermal injury in rats. Burns, 2010, 36(1): 75-81.
19. Steven K, And, et al. Mediastinal lymph node dissection improves survival in patients with stages Ⅱand ⅢA non-small cell lung cancer. Ann Thorac Surg, 2000, 70(2): 358-365.
20. Wu Y. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
21. Izbicki JR, Passlick B, Pantel K, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg, 1998, 227(1): 138-144.
22. Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage ⅠA lung cancer. World J Surg, 2000, 24(1): 27-31.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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