Pelvic exenteration (PEx) in female patients involves (1) the en bloc removal of some or all of the pelvic organs (variably including the anal canal, vagina, vulva and perineum, and sacrum), (2) urinary and/or faecal diversion and, (3) reconstruction of the defect in the pelvic floor, with or without vaginal reconstruction. Whilst first described as a palliative procedure, PEx is most often performed with curative intent for recurrent pelvic cancers which have been previously irradiated. It is less often performed for locally advanced/persistent disease following primary treatment with radiotherapy or chemoradiotherapy (except for some cases of locally advanced rectal cancer), and is rarely performed with palliative intent. Pelvic recurrence may be central, extend to the pelvic sidewall or only on the pelvic sidewall. As all patients who undergo PEx face a significant risk of morbidity and mortality, careful case selection is fundamental to optimise oncological outcomes and minimise morbidity. Furthermore, these operations are life changing, can have long term effects on the quality of life and, despite such extensive procedures, the cancer may recur in the pelvis or distally. The 5-year survival after PEx is around 50%. Overall about 50% of PEx patients experience one of more significant complications. The complications particular to PEx operations are discussed here, where the focus is on central pelvic relapse.