The lymphatic system, a complex and dynamic network comprising lymphatic vessels, lymph nodes (LNs), and associated lymphoid tissues, plays a pivotal role in regulating interstitial fluid balance and providing immune surveillance across the body. In cancer, however, the lymphatic system often transforms into a pathway for malignant cell dissemination, leading to lymphatic metastasis—a significant step in tumor progression associated with worse patient prognoses. Mechanistically, tumor cells exploit lymphangiogenic pathways to facilitate their entry and spread within the lymphatic network. Key mechanisms in this process include the upregulation of vascular endothelial growth factors C and D (VEGF-C/D), which promote lymphatic endothelial proliferation, vessel dilation, and increased permeability. This review seeks to provide an in-depth examination of the biological mechanisms underpinning lymphatic metastasis, explore its impact on cancer progression, and highlight current and emerging strategies aimed at managing metastatic disease.

Academic engagement plays a central role in education, leadership development, and career advancement in Plastic Surgery. While other surgical specialties have evaluated the financial barriers to such involvement, plastic surgery lacks a comprehensive cost analysis. This cross-sectional observational study seeks to quantify the cumulative costs associated with academic participation across societies, meetings, and publishing platforms. Major plastic surgery societies, meetings, and journals were identified by two authors through author consensus and web-based searches. Cost data was collected in 2025 from official online sources or directly from society and meeting coordinators. A baseline academic engagement (BAE) cost was calculated for newly board-certified surgeons, and total lifetime costs were estimated assuming a 34-year clinical career. Descriptive statistics were used to summarise costs across categories and subspecialties. The average BAE was $19,367.32, with an annual continuation cost of $15,176.72. Over a 34-year career, the total estimated cost of academic engagement was $520,199.08. Median conference attendance cost was $876 for members, excluding travel and lost productivity. CME credit acquisition averaged $47.20 per credit for members and $55.71 for nonmembers. Journal subscriptions and open-access publication fees further added to the financial burden. Costs were highest in aesthetic and craniofacial subspecialties. The cumulative costs of academic participation, including society membership, conference attendance, and publication, may limit engagement, particularly for early-career, international, and private practice surgeons. Expanding virtual CME options, increasing scholarship availability, and reevaluating CME accreditation criteria may help reduce disparities and ensure broader, sustained involvement in academic plastic surgery.

Lower extremity lymphedema (LEL) is a debilitating disease causing limb enlargement secondary to fluid accumulation. Although vascularized lymph node transfer (VLNT) has emerged as a promising option for refractory cases, data are limited by small samples and inconclusive results. This systematic review and meta-analysis aims to assess metrics of symptom improvement after VLNT and the impact of donor sites on outcomes. This study was performed per the PRISMA guidelines and registered on PROSPERO (#CRD420251243270). The PubMed, Scopus, and CENTRAL databases were searched until February 2026. Studies on lower limb VLNT were included and combined techniques were excluded. Outcomes included circumference reduction rate (CRR), limb volume, and complications. Descriptive statistics, chi-square, and meta-analyses were performed. Risk of bias was assessed using the Newcastle Ottawa and Joanna Briggs Institute Scales RESULTS: Twenty five studies were included and comprised 395 unique patients (70.28% female). Above and below knee CRR were 24.79% and 29.50% with high reduction in flaps using the gastroepiploic donor site (p = 0.002, p < 0.001, respectively). Limb volume was decreased by 25.32% and cellulitis incidence was significantly decreased postoperatively (p < 0.001). Adverse events were low at 12.22%. VLNT is a safe and effective technique for LEL treatment with substantial CRR, limb volume reduction, and cellulitis incidence. Outcomes were significantly improved with gastroepiploic flaps, suggesting that they should be most used for lymphedema treatment. Limitations include potential reporting bias and retrospective nature of studies. Future prospective studies should further evaluate outcomes based on different donor and recipient sites.