Here, we report a case of recurrent rectal cancer successfully treated with resective surgery using the extraperitoneal approach. A 73-year-old man underwent the Miles operation for advanced rectal cancer (Rb-P, tub1, pMP, pN0, Stage I). At 20 months after the initial operation, computed tomography( CT) and magnetic resonance imaging( MRI) scans and 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) images showed a recurrent pelvic tumor( 20 mm in diameter) located in the lower presacral region. The tumor was surgically excised. The presacral space was easily exposed by the surgical procedure using the extraperitoneal approach, and the tumor was easily dissected and resected. We conclude that a surgical procedure using the extraperitoneal approach might be effective for the treatment of pelvic recurrence of rectal cancer.
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