Dear Editor-in-Chief, We were interested to read the recent publication from St. Mark’s Hospital, London, concerning extended lateral pelvic side wall excision (‘ELSiE’) for locally advanced or recurrent anorectal cancer extending out through the greater sciatic foramen [1]. The authors report achieving an R0 resection in all six patients, something they credit to a certain extent on their new two-stage ‘ELSiE’ technique.Interestingly, ELSiE involves starting with the patient prone to dissect from outside to inside the pelvis and then turning the patient over to complete the procedure in a modified Lloyd-Davies position. This contrasts to our preference to perform the vast majority of exenterations, including extended lateral pelvic side wall excisions, in a one-stage procedure with the patient in the abdomino-lithotomy position [2, 3]. We believe that this confers certain advantages including: simultaneous access to the abdomen and key vessels of the pelvis; the ability for two surgic ...