Pelvic exenteration for locally recurrent rectal cancer can achieve high rates of R0 resection, with important predictors identified for optimizing outcomes.

• R0 resection was accomplished in 81% of patients (244/300).
• Neoadjuvant radiotherapy significantly improved R0 resection rates (OR=2.773).
• Age influences overall survival, with a hazard ratio of 1.022 per year increase.

Use these insights to refine patient selection and enhance preoperative counseling, aiming for better shared decision-making.