Presacral recurrent rectal cancer which involves the presacral fascia and/or sacral bone is one subtype of locally recurrent rectal cancer. Presacral recurrent rectal cancer is fixed posteriorly to the pelvis due to presacral fascial and/or sacral bone involvement, which makes treatment difficult. There is lack of standardized diagnosis, treatment and surgical methods of presacral recurrent rectal cancer. The purpose of this expert consensus is to improve the understanding of this condition among Chinese specialists, and to help standardizing the diagnosis and therapeutic strategies for presacral recurrent rectal cancer. There are 17 statements on diagnosis (clinical symptoms, imaging, endoscopy, tumor marker detection and pathological biopsy), treatment (radiotherapy, chemotherapy and surgery), follow-up and prognosis for presacral recurrent rectal cancer. It is emphasized that radical surgery with the evaluation of multidisciplinary team (MDT) is the core method for the treatment. The choice of surgical approach should be based on the anatomic characteristics of presacral recurrence. The controversial issues in this consensus requires to further high-quality clinical research.