Purpose: Pelvic exenteration for rectal cancer involves a radical multi-visceral resection to improve complete surgical clearance, and access is limited within Queensland. Methods: A retrospective review of a prospective database of the referrals to the pelvic exenteration service in the Royal Brisbane and Women’s Hospital from 2009-2023. Geographic, as well as clinical and demographic information was collected. Results: 176 patients were referred to the pelvic exenteration service. In total 93 patients were referred from a major city, 52 from inner regional areas, and 31 from outer regional or remote areas. 103 referred patients (58.5%) proceeded to surgery, significantly more of whom were referred from a major city (p <0.001). Of the patients referred from outer regional, inner regional, and major cities, a similar proportion of patients proceeded to surgery (55%, 52%, and 63.4%). Patients not proceeding to surgery in major cities and inner regional areas were most commonly unfit to proceed, whereas in outer regional areas most patients decided against surgery (61.5%). In the fourteen-year period, overall referrals increased, with inner regional referrals increasing the most over time. Conclusion: Awareness of the pelvic exenteration service in regional Queensland may have resulted in less referrals to the service. It is important to confirm a broad-reaching service to optimise patient care.