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To evaluate 66 patients undergoing pelvic exenteration forprimary advanced rectal cancer and locally recurrent rectal cancer.All patients were registered on aprospective clinical database. They were evaluated with PET/CT, CT, and MR. There was no evidence of disseminated disease and the patients were discussed at a MDT conference.Pelvic exenteration was performed in 66 patients (30 with locally recurrent rectal cancer and 36 withprimary advanced rectal cancer). Their median age was 64 (range 34-79), eight women and 58 men. Forty-six patients received a VRAM flap and four patients a gluteal flap. Thirty patients received postoperative brachytherapy. R0 resection was possible in 34, R1 in 29, and R2 in three patients. Twenty-six were without any complications. Seventy-six complications were registered - 36 minor and 40 major complications. One patient died within 30 days (1.5%). Follow-up was 20.5 months (range 0.7-106.4). The 5-year survival forprimary advanced rectal cancer was 51.5% and for locally recurrent rectal cancer 18.5%.Pelvic exenteration is associated with considerably morbidity, but low mortality. Pelvic exenteration can achieve long-term survival especially for patients withprimary advanced rectal cancer. However, pelvic exenteration is also justified for patients with locally recurrent rectal cancer.