Background Pelvic exenteration is a curative option for select patients with locally invasive or recurrent colorectal cancer. Achieving clear surgical margins (R0 resection) is essential for optimal oncological outcomes and quality of life. Minimally invasive surgery (MIS), including laparoscopic and robotic techniques, offers improved visualization and precision. However, its feasibility and outcomes compared to open surgery remain uncertain due to limited data. This review aims to compare MIS with open pelvic exenteration in this context. Methods A systematic review and meta-analysis identified studies comparing MIS and open approaches for pelvic exenteration in colorectal cancer. Key parameters evaluated included surgical performance, recovery metrics, and oncological outcomes. Study quality was assessed using the Newcastle-Ottawa Scale, and the GRADE framework was applied to evaluate evidence certainty. Results Seven retrospective studies involving 564 patients were analysed. R0 resection rates were comparable between MIS and open surgery (RR = 0.74, 95% CI 0.36–1.51, p = 0.41, I² = 19%). Other comparable factors included lymph node harvest, operative time, morbidity, anastomotic leak rate, and postoperative ileus. MIS demonstrated significant benefits, including reduced intraoperative blood loss, shorter hospital stays, and improved 3-year overall and disease-free survival rates. Conclusion MIS and open surgery achieve similar R0 resection rates in pelvic exenteration for colorectal cancer, with MIS offering recovery and survival benefits. However, current evidence is limited by retrospective studies with selection bias. Prospective studies focusing on robotic techniques are needed to confirm these findings.