This book analyzes all aspects of modern multimodal treatment of locally recurrent rectal cancer in the pelvis in order to offer a panoramic overview of the different therapeutic options and enable the reader to balance their benefits and drawbacks. Indications for surgery and the surgical techniques themselves, including reconstruction techniques after major exenterative surgery, are clearly described and evaluated. The role of new imaging tools, such as MRI and PET-CT, in staging recurrences and guiding therapy is assessed, and detailed consideration is given to the use of neoadjuvant and iterative radiotherapy and the indications for systemic chemotherapy. Morbidity, mortality, oncologic outcomes, and quality of life issues are carefully analyzed, and options for pain control and palliation are examined. Finally, a national survey is presented on the state of the art in the surgical treatment of locally recurrent rectal cancer in Italy.  While there has been a dramatic fall in the incidence of local pelvic recurrences, their treatment remains a major clinical challenge which requires a multidisciplinary approach and careful selection of the most appropriate strategy in each case. This book will aid practitioners in making the correct decisions in individual patients.