Management of chronic cough after video-assisted lobectomy with pulmonary vagus nerve transection

A recent study showed that in patients who underwent video-assisted lobectomy and lymphadenectomy, the transection of the pulmonary branches of the vagus nerve that innervate the bronchial stump, as well as the caudal-most large pulmonary branch, resulted in a reduction in the rate of chronic cough. Additionally, this intervention did not affect pulmonary function. This study’s findings were published in the International Journal of Surgery.

This was single-center, randomized trial that included patients who were scheduled for elective video-assisted thoracoscopic lobectomy and lymphadenectomy. These patients were randomly assigned to two groups: the control group (n=58) which underwent a sham procedure, and the vagotomy group (n=58) which underwent a pulmonary vagus nerve transection. The primary outcome of the study was the rate of chronic cough, which was assessed 3 months post-surgery.

At 3 months post-surgery, in the vagotomy group, the chronic cough rate was 19.0% (11/58), while in the control group, it was 41.4% (24/58). In the 108 patients assessed after 2 years, the persistent cough rate was 1.9% (1/53) in the vagotomy group and 12.7% (7/55) in the control group. There were no significant differences between the two groups in terms of postoperative complications and important pulmonary function measures.

Thus, it can be concluded that patients who underwent video-assisted lobectomy and lymphadenectomy experienced a decrease in chronic cough rate without any impact on pulmonary function following the transection of pulmonary branches of the vagus nerve responsible for innervating the bronchial stump, along with the caudal-most large pulmonary branch.