Would you recommend an inguinal node dissection as part of definitive treatment for adenocarcinoma of the anus with suspicious inguinal nodes?   

The only wrong way to approach this is with initial inguinal surgery. I have seen that result on multiple occasions in dermal lymphatic recurrence after standard IMRT because the drainage  gets altered. True adenocarcinoma of the anal canal has a poor prognosis due to increased rates of distant...