Effects of Preserving the Pulmonary Vagus Nerve Branches on Cough After Pneumonectomy During Video-Assisted Thoracic Surgery

Abstract

BackgroundCough is one of the most common complications of early-stage non-small cell lung cancer (NSCLC) after video-assisted thoracoscopic surgery (VATS). The vagus nerve plays an important role in pulmonary inflammation and the cough reflex. In this study, we attempted to reduce the incidence of postoperative chronic cough and other complications by preserving the pulmonary vagus nerve branches.Patients and MethodsThis study was a randomized controlled double-blinded trial of subjects and observers. A total of 158 NSCLC patients were enrolled. We randomly assigned 79 patients to Group A (pulmonary branch of vagus nerve preservation group) and 79 cases to Group B (conventional surgical treatment group). In the final analysis, 72 patients from Group A and 69 patients from Group B were included. The main outcome measure of the study was the occurrence of CAP or other postoperative complications within five weeks. This trial was registered with ClinicalTrials.gov (number NCT03921828).ResultsThere was no significant difference in preoperative general clinical data between the two groups. No death during the perioperative period occurred in either of the two groups. There was no significant difference between the two groups in operation time, intraoperative bleeding, number of lymph nodes sent for examination, number of cases transferred to ICU after operation, postoperative catheterization time, or postoperative hospital stay (P>0.05). There was no significant difference in other pulmonary and cardiovascular complications between the two groups, including pulmonary infection (2.78% vs. 8.70%, P = 0.129), atelectasis (1.39% vs. 0%, P = 0.326), pleural effusion (2.78% vs. 1.45%, P = 0.585), persistent pulmonary leakage (2.78% vs. 2.90%, P = 0.965), arrhythmia (2.78% vs. 1.45%, P = 0.585), and heart failure (0% vs. 1.45%, P = 0.305). The incidence of CAP in Group A was significantly lower than that in Group B (13.89% vs. 30.43%, P = 0.018). The LCQ-MC scores in Group A were significantly higher than those in Group B at two and five weeks after operation (P<0.05). Univariate and multivariate analysis showed that the risk factors for postoperative CAP were surgical side (right lung), surgical lung lobe (upper lobe), preservation of pulmonary branch of the vagus nerve during operation, and duration of anesthesia.ConclusionsPreserving the pulmonary vagus nerve branches during VATS in patients with stage IA1-2 NSCLC can reduce the incidence of postoperative CAP.

Preoperative fractional exhaled nitric oxide can predict postoperative cough-related quality of life and its recovery for early-stage non-small cell lung cancer patients: a longitudinal study

“…fentanyl, sufentanil, remifentanil and alfentanil), are widely used in the induction and maintenance of anesthesia, have been reported to cause the development of postoperative cough [32,33]. Although this study failed to corroborate above risk factors, we did observe that the longer duration of anesthesia may be associated with a greater risk of postoperative cough, in agreement with many previous studies [7,9].…”

“…In this study, we found that the longer duration of anesthesia was a signi cant risk factor of postoperative cough, in agreement with many previous studies [7,9]. It is important to consider factors during anesthesia that may explain this result, such as.…”

“…Regarding postoperative symptoms, cough is a most common respiratory symptom, affecting physical, psychological, and social aspects of daily life; contributing to fatigue and insomnia; increases anxiety in patients; and leading to social isolation [5]. Several recent studies have revealed that postoperative cough occurs in 30.0% to 46.0% of NSCLC patients after VATS, and gender, duration of anesthesia, mediastinal lymph node dissection (related to surgical side), injury of vagus nerve lung branch or bronchial artery were independent risk factors [6][7][8][9].However, morbidity and distress levels due to postoperative cough have been underestimated, especially after discharge, representing an unmet clinical need [10].…”

Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis

“…Possible reasons for the increased arrhythmia in S-LND could be the increased extent of resection 33 and manipulation around the vagus nerve branches. 34 , 35 In this analysis, we could not specifically determine the impact of different arrhythmia types because of the limited information available in each study. Future studies concerning this topic would assist in expanding our understanding of the long-term detrimental effect of postoperative arrhythmia in lung surgery.…”

Pulmonary Rehabilitation Exercises Effectively Improve Chronic Cough After Surgery for Non-small Cell Lung Cancer

“… 1 Approximately 25%-50% of patients presented with short-term postoperative cough. 2 , 3 Short-term cough after lung cancer surgery was more often associated with surgery and anesthesia, such as injury to the vagus nerve or its branches, 4 lymph node dissection, 5 anesthetic drugs, 6 and tracheal intubation. 7 Unlike short-term postoperative cough, some patients may suffer from a persistent chronic cough that persisted beyond the initial recovery period from surgery.…”