A 59-year-old woman underwent surgical removal of a pT3N3M0 rectal adenocarcinoma (RAC) through an abdominal-perineal approach followed by chemoradiotherapy (CHT-RT) in 1995. She underwent a right inferior lobectomy for a lung metastasis 3 years later, followed in 2000 by an additional intervention for a second metastasis that was treated by a left superior atypical lobectomy and CHT. The patient complained 1 year later of dysphagia and an anterior neck mass was found. US examination detected a multifocal lesion in the thyroid gland with involvement of the strap muscles, which was confirmed by FNAB to be a third RAC metastasis. A palliative course of RT was performed, but no regression of the lesion was observed. Crico-tracheal infiltration was also suspected after CT scan. The patient was in good general condition and strongly favored surgery. In August 2001 she underwent total thyroidectomy, total parathyroidectomy, strap muscles excision, central compartment neck dissection and crico-tracheal resection and anastomosis involving the anterior arch of the cricoid between the crico-thyroid joints and the first three tracheal rings. She was extubated at the end of the surgical procedure with no tracheotomy, started an oral diet the day after, and was discharged without complications 9 days later. She was followed up monthly by endoscopy and has undergone one CT and two MR scans at 6-month intervals. The patient had no RAC recurrence in the neck when last seen 26 months after surgery. During this time, she underwent four further lung metastasectomies followed by CHT.