The objective of this study was to describe and compare the outcome of patients with recurrent adenocarcinoma versus squamous cell carcinoma of the uterine cervix who have been treated with pelvic exenteration. All patients undergoing pelvic exenteration for cervical adenocarcinoma from 1955 to 1989 were identified and a retrospective review was conducted. For these 35 patients, we identified 70 controls who had exenteration for squamous cell carcinoma and who were matched for node status, year of procedure, and type of procedure. No significant difference was noted between the control group and the adenocarcinoma group for size of recurrent tumor, status of margins, presence of hydronephrosis prior to exenteration, and the time elapsed from initial diagnosis to exenteration. The two groups were compared for survival and recurrence pattern. Median patient age was 47 years (range 22-70). All patients had prior pelvic radiotherapy. Thirty patients had total pelvic exenteration and 5 had anterior exenteration. There were 3 postoperative deaths (8.6%). Median survival was 38 months for the adenocarcinoma patients and 25 months for the squamous patients (P > 0.99). The overall survival between the two sets of patients was very similar (log rank P = 0.86). There were 23 postexenteration recurrences among the adenocarcinomas (22 in which the site is known) and 32 postexenteration recurrences among the squamous patients (30 with known site). For the adenocarcinoma patients, 14 of 22 had a distant recurrence versus 14 of 30 for the squamous patients (P = 0.27). Patients with central recurrence of cervical adenocarcinoma can be successfully treated with pelvic exenteration and have survival rates similar to squamous carcinoma.