When treating a low-lying and bulky cT2N0 rectal adenocarcinoma invading the anal sphincter muscles with neoadjuvant chemoRT for downstaging, would you electively include the inguinal lymph nodes?

Based on the paper that we published at MDAnderson in 1990, the inguinal recurrence rate is 2 to 5% if they are not treated electively in patients with tumors involving the anal canal. If the tumor is within 2 cm of the anal verge or right at the dentate line, it was 5%. If the tumor was between two...

There is a surprisingly scant amount of rad onc literature on this topic. There are a number of surgical papers from the 90s and 2000s though, some of which have even recommended inguinal dissection for clinically positive nodes (for purposes of cure).

The AJCC still considers the inguinals a metasta...