Introduction: To evaluate the surgical, pathological, and perioperative outcomes of pelvic exenteration with and without bone resection in patients with locally advanced (LARC) or recurrent rectal cancer in a Chilean public hospital. Methods: A retrospective study of 14 patients who underwent pelvic exenteration between January 2016 and December 2023. Demographic variables, use of neoadjuvant and adjuvant therapy, type of resection, margin status, 90-day complications, and mortality were analyzed. Outcomes were compared between groups with and without bone resection. Results: The median age was 54 years (IQR: 49.25-56.75) with a male predominance (78.57%). 50% of the patients received neoadjuvant treatment and 50% required bone resection. There were no significant differences in age, gender, or neoadjuvant treatment between the groups. The rate of negative margins (R0) was 71.43%. The 90-day readmission and reoperation rates were similar between the groups. No deaths were recorded within 90 days postoperatively. Discussion and Conclusions: Pelvic exenteration with and without bone resection in a Chilean public hospital showed outcomes comparable to international literature, with high rates of complete resection (R0) and no short-term mortality. These results highlight the importance of a multidisciplinary approach in the management of LARC and recurrent rectal cancer.