Purpose – Pelvic exenteration (PE) is a radical resection that offers a potentially curative procedure for patients with locally advanced or recurrent colorectal cancer. While most clinicians adopt follow-up schedules of low-grade colorectal cancer, this practice is unclear and questionable. The aim of this systematic review was to evaluate the oncological and functional follow-up strategies after PE. Methodology – A comprehensive literature search was conducted across PubMed, Embase, Medline, and Cochrane databases for studies published between January 2000 and December 2024. Inclusion criteria focused on studies reporting long-term oncological and functional follow-up of PE patients. Two independent reviewers performed study selection, data extraction and risk of bias assessment (AGREE-II and ROBINS-I). Results – Forty-two studies were included, comprising 39 cohort studies and three non-original research articles. Oncological follow-up, described in 28 studies, frequently included clinic visits every 3–4 months for the first 2–3 years, transitioning to annual reviews after five years. Modalities such as tumour markers, CT and MRI imaging, and colonoscopies varied widely. Functional follow-up was addressed in 19 studies, utilising validated instruments like the EORTC QLQ-C30 and SF-36. Most studies lacked standardisation, and no single article comprehensively addressed both oncological and functional aspects. Conclusion – Current follow-up practices after PE exhibit significant heterogeneity, highlighting the need for standardised protocols. Future research should focus on RCTs and large-scale prospective studies to develop evidence-based guidelines tailored to the unique needs of this high-risk patient population.