Penile cancer and lymph node management: a call for standardization

Purpose: This study aims to compare and organize recommendations from the most eminent international guidelines on the staging and treatment of lymph node (LN) involvement in penile cancer (PC). Early recognition and appropriate management of nodal disease remain the cornerstone of care, influencing both survival and treatment-related morbidity. Methods: This study compares and organize recommendations form the most eminent international guidelines—including NCCN, ESMO-EURACAN, and EAU-ASCO—on the staging and treatment of lymph node involvement in penile cancer. Results: Open inguinal LN dissection (ILND) remains the standard treatment for not superficial cancers and its morbidity has driven interest in minimally invasive surgical approaches, such as video-endoscopic inguinal lymphadenectomy (VEIL), including its robot-assisted variant (RA-VEIL). Their role is well defined in clinically node-negative (cN0) patients but remains investigational in node-positive (cN+) cases. For cN3 disease and pelvic node involvement, multimodal strategies including chemotherapy, surgery, and radiotherapy are required. Conclusion: The variability among guidelines underscores the need for collaborative efforts and high-quality prospective trials to refine and standardize treatment recommendations.