Gastrointestinal stromal tumors (GISTs) rarely arise in the rectum. Whereas a 
local resection with negative margins is generally considered adequate for 
resectable GISTs, a wide resection is usually indicated for rectal lesions 
because of the technical impossibility of local resection. We report the cases 
of two patients who underwent resection of a rectal GIST using a transsacral 
approach. Both patients had an uneventful postoperative course, and no evidence 
of recurrence has been identified. The transsacral approach appears to be less 
invasive and should be considered as the treatment of choice for a rectal GIST.