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Brunschwig and Walsh described “resection of the great veins of the lateral pelvic wall” to gain clearance for advanced gynecological tumors in the late 1940s [60]. However, extension of pelvic cancer into the pelvic sidewall was traditionally been considered contraindication to resection. Due to the technical difficulty of safely attaining an R0 resection margin. Efforts at vascular reconstruction were hampered by the procedure being frequently preformed in a grossly contaminated and often previously heavily irradiated field [61]. Due to these poor early outcomes, few undertook such radical resections until very recently [62].

Contemporary studies have reported en‐bloc resection of the pelvic sidewall for both locally advance and recurrent rectal cancer involving the lateral pelvic neurovasculature with good outcomes [63]. Similarly, extended lateral wall resection is possible in advanced gynecological tumors [64]. Some units are providing “higher and wider” resections for tumors involving the common and external iliac vessels [65, 66] and extending to the sciatic nerve and ischial bone [2, 57, 67]. Reported R0 resection rates range from 38 to 58%, with no perioperative mortality, and 96–100% long‐term graft patency [65, 66].