Surgical treatment of recurrent rectal tumors is a challenge for cancer surgeons. Due to the high risk of intraoperative and postoperative complications, such tumors are often considered inoperable. We present a clinical case of 56-years-old male patient with local recurrence and pathological fracture of the sacrum at S5 level to whom en-bloc distal sacrectomy was performed. Such surgical technique for recurrence of rectal cancer provides significant improvement in local and general condition and creates a favorable prognosis for the patient's survival, which is demonstrated by the described clinical case.