Advances in surgical technique and in integrated treatments allow today to anticipate an extreme plan of cure even for far advanced and metastatic neoplasms of the rectum.

The video shows the case of a 67-year old man affected by cancer of the lower rectum infiltrating the prostatic capsule, with multiple and bilobar hepatic metastases (1 in the left lobe and 5 in the right liver). A plan of sequential radical surgery is achieved through two operations: in the first one, a restorative proctectomy extended to the prostatic capsule is performed along with the excision of the only metastasis of the left lobe of the liver and absence of signs of disease progression, a second procedure of right hepatectomy is performed.

The patient recovered with complications after both the procedures. At 8 months follow-up, the complete recovery of continence was documented by defecography, while CT scan showed the absence of residual hepatic disease. The patient at present has completed the program of radio-chemotherapy and remains in good general health conditions.

In selected forms of far advanced rectal cancer, an aggressive approach to disease technically amenable of complete removal can allow for a surgical procedure with perspective of cure, without compromising the functional results.