The European Association of Urology (EAU) recommends a risk-adapted approach to removal of inguinal lymph nodes during surgery for penile cancer. In this way, men who are unlikely to derive a survival benefit from the procedure will be spared the associated morbidity. Recently, two groups have tested the real-world utility of the EAU guidelines. The guidelines recommend inguinal lymphadenectomy for patients at high risk of occult metastasis; that is, those with pT2-pT4 and grade 3 disease, or evidence of lymphovascular invasion. Following an anecdotal observation that few such patients actually undergo the recommended procedure, Timothy Johnson and his US-based collaborators interrogated the Surveillance, Epidemiology and End Results (SEER) database.
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