The authors analyse pelvi-perineal recurrence after amputation of the rectum on the basis of 47 cases followed for a minimum of two years, 10 of which developed recurrences. The diagnosis, always difficult and delayed, can be made earlier by using pre-operative computed tomography. However, the recurrences can be resected in only a limited number of cases. The routine use of more radical operations and extensive lymphadenectomy and the decreased use of mechanical sutures have not improved the results. The essential approach must therefore consist of the detection of stage A tumours and precancerous lesions followed by adaptation of the resection technique according to the degree of extension of the tumour.