Local recurrence of rectal cancer following abdominoperineal resection is rarely amenable to limited resection. Computed tomographic (CT) study of the pelvis revealed recurrent tumor images in relation to the adjacent pelvic structures. Five patients with deeply invading recurrent lesions were submitted to pelvic exenteration combined with sacral resection. No postoperative deaths were encountered. The postoperative sharp drops of serum CEA levels are useful for judging the adequacy of this procedure. The follow-up status of the 5 patients, respectively: 14 months alive with pulmonary metastasis, 9 months alive without symptoms but with slightly elevated CEA levels, and 8 months, 3 months, and 3 weeks alive with no evidence of disease. All patients who were relieved of perineal or sciatic nerve pain are now able to walk without any assistance or trouble. Total en bloc residual pelvic exenteration combined with sacral resection is a reasonable treatment for locally recurrent rectal cancer.