Cervical cancer has been and still is a major global health problem and a major treatment
challenge for which surgical interventions have played a key role throughout the past
century. In early stages (I/A2-II/B), where high-risk factors are not present, the
efficacy of surgical and radiotherapy treatment has been considered equivalent with
different (treatment modality specific) complications and quality of life consequences.
Negative prognostic factors in early stages of the disease (pelvic lymph-node positivity)
and in more advanced stages (parametrial and/or surgical margins' tumor involvement)
forecast the deterioration of outlooks for good life expectancy. In these high-risk
cases, when radio- or chemoradiotherapy is contraindicated, we investigated the potential
role of a more radical surgical approach than the traditional radical hysterectomy.
Twenty-five years ago, a hyperradical surgical procedure for the treatment of high-risk
cervical cancer patients was introduced in Budapest. The procedure was named as laterally
extended parametrectomy (LEP) in Budapest Hungary. The surgical intention was the
complete removal of the fibro-fatty tissue content of the pelvis, which contains the
lymphatic vessels, lymph nodes, and tumor-affected pelvic side wall structures. We
initiated observational studies on the primary treatment in parametrium and/or lymph-node
tumor-positive early-stage cases and on second-line surgical therapy of pelvic side
wall recurrent tumors following radiotherapy. Promising results of our observational
studies propose that prospective randomized trials are worth to be initiated to clarify
the potential of this treatment modality in this poor prognosis cohort of patients.
