A 66-year-old woman presented with discharge of necrotic tissue and bleeding from the vagina during uterine cancer screening. She was diagnosed with lower rectal cancer cT4b(vagina)N3M0, cStage Ⅲc. As the tumor protruded into the lumen from the posterior vaginal wall, preservation of the anterior vaginal wall was challenging. Robot-assisted total pelvic exenteration with vulvectomy was performed. The patient was discharged without any apparent postoperative complications. Upon histopathological examination, the lesion was identified as being pT4bN0M0, pStage Ⅱc. Six months after the surgery, no recurrence or decline in the performance status was noted.
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