Abstract Aim Total pelvic exenteration (TPE) is a complex but potentially curative option for advanced pelvic malignancies. This study aims to evaluate long-term outcomes after TPE. Method Between February 2010 and February 2020, 88 patients who underwent TPE at our institution were included. Data extraction was done by retrospective examination of patient records. Incidence of perioperative complications, long-term outcomes and survival were noted. Results The mean age was 62.6 years (29-87 years). Colorectal malignancy (75%) was the most common indication. 63.7% of patients received chemo or radiotherapy or both pre-operatively. Median follow-up was 54 months (33.25 – 80.25 months). At 30 and 90 days, 20.5% and 8% of patients had a Grade 3 complication or above respectively. Complications related to urinary diversion were noted in 10 patients (14 events - 4 urinary leaks, 6 stoma related complications and 4 ileo-ileal anastomotic leaks). The 30- and 90-day mortality rate was 1.1% and 2.3% respectively. At 1, 3, and 5 years, overall survival was 89.8%, 64.8% and 63.6% respectively and cancer specific mortality was 5.7%, 18.2% and 31.8% respectively. Average glomerular filtration rate was 24.2 ml/min/m2 (p<0.0001), 34.1% developing new onset chronic kidney disease 3B or worse and 3.4% requiring haemodialysis. 18.2% of patients required further urological intervention. There was no statistically significant difference in ureteric stricture rates between patients undergoing surgery for recurrent disease (p=0.86) or following prior radiotherapy (p=0.81). Conclusions TPE appears to provide long-term survival in over 60% of patients with advanced pelvic malignancies. Long-term complications are predominantly related to the urinary diversion requiring prolonged urological follow-up.