DEfeating PEnile CAncer-2

Open inguinal lymphadenectomy (O-ILAD) is the current standard of care for invasive staging and simultaneously the curative approach for patients with PeCa and elevated risk for or clinically detectable lymphatic disease in the groin. The high rate of complications of this surgical procedure, which are often mutilating and associated with a long-term convalescence, leads to a critical delay in initiation of adjuvant systemic therapy. Being in apprehension of these postsurgical adversities, physicians are often reluctant with indicating this procedure, thus depriving their patients of the vital prognosis-relevant care. In the sum, these obstacles inevitably result in inferior oncologic outcomes. Aiming to decrease postsurgical detrimental sequelae, several attempts to modify radicality of the technique, including inter alia a radioguided approach of sentinel lymph node resection, have been presented in the last decades. Unfortunately, utilization of the sentinel lymph node technique outside of a few highly specialized referral centers is prone to a significant false negativity, while other approaches are associated with inconsistent oncological and perioperative outcomes, hence precluding a general breakthrough in the surgical management of the groin lymph nodes. Thus, a high unmet medical need exists for the establishment of an approach with the lowest possible rate of complications and at the same time the optimal oncological safety.

In this context, preliminary evidence from small sample studies points to a promising potential of minimally invasive surgery to be further tested in the setting of inguinal lymphadenectomy. A recent retrospective single-center report on robot-assisted inguinal lymphadenectomy (R-ILAD) showed that the rate of major complications was only as low as 2%. On the contrary, the rate of major complications in our own and other O-ILAD series was approx. 30%.

DEPECA-2 is a prospective randomized multicenter trial, in which R-ILAD will be tested vs. O-ILAD on the 1b level of evidence for the first time. The scientific value of the project is significantly substantiated by a comprehensive translational research program, which includes inflammatory and oncologic biomarker research, as well as functional validation in preclinical models. The results of this trial will foster further optimization of outcomes in the surgical management of PeCa.