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.