Vagus nerve and phrenic nerve guided systematic nodal dissection for lung cancer

Systematic nodal dissection (SND), which is defined as “all the mediastinal tissues containing the lymph nodes are dissected and removed systematically within anatomical landmarks”, is vital in surgical treatment for patients with non-small cell lung cancer (NSCLC) with curative intent (1). However, for avoiding surgical complications or other reasons, a variation of SND affects the thoroughness of lymph node dissection and the accuracy of pathologic nodal (pN) staging, which are the most significant prognostic factors in resectable NSCLC (2,3). Also, reduction in the severity and incidence of postoperative complications, such as nerve injury, is of utmost importance and remains challenging (4). Although some studies reported the experience and skills in mediastinal lymph node dissection (4,5), a standard and systematic procedure for nerve protection are still lacking. Therefore, an easy-to-follow standardized approach of SND, which can not only achieve regional en bloc lymph node resection but also effectively protect the nerves, is critically needed.