Reply: Lymph stasis promotes tumor growth

Our study suggested that surgical damage of the lymphatic system promotes tumor progression via impaired immune response. However, as pointed out by Valerio et al, lymph stasis is likely to induce immune stasis, resulting in not only enhanced tumor growth but also tumor generation. Although mechanisms of the tumor generation may not only include impaired immune response but also other factors induced by lymph stasis, we should avoid unnecessary lymphatic disruption in any surgeries and carefully consider the flap design to minimalize lymphatic disruption even in cases with benign tumors.