We performed a retrospective review of 68 patients who underwent pelvic exenteration for colorectal adenocarcinoma. Forty-seven patients had surgery for primary disease and 21 for recurrence. Clinical recurrence developed in 30 (44%) of 68 patients overall. Of these, 17 (57%) developed locoregional disease only as their first recurrence. This included nine (56%) of 16 patients with primary disease and eight (57%) of 14 patients with recurrent disease. Clinical recurrence developed in 16 (34%) of 47 patients with primary disease and 14 (66%) of 21 patients with recurrent disease. The overall 5-year survival rates were 43% and 20%, respectively. We conclude that locoregional recurrence remains a significant problem for primary or recurrent colorectal carcinoma even after radical pelvic surgery.