This study aimed to evaluate the outcomes of pelvic exenteration (PE) in patients with recurrent or persistent cervical cancer, with emphasis on whether modern advancements—timely diagnosis, surgical refinement, and multidisciplinary perioperative care—have addressed traditional concerns regarding morbidity, quality of life, and survival. This was a retrospective study conducted at a tertiary cancer center from January 2021 to December 2023. In total, 25 patients who underwent PE for recurrent (60%) or persistent (40%) cervical cancer were included. All patients were evaluated with PET-CT and pelvic MRI for operability. Tissue diagnosis was confirmed using TRUS, TVS, EUA, or cystoscopic biopsy. Surgical outcomes, complications, margin status, survivals, and quality of life were assessed using EORTC QLQ-C30 and Stoma-QOL tools. Median age was 58 years. Total PE was performed in 56%, anterior in 40%, and posterior in 4%; 28% were robotic. R0 resection was achieved in 100%. Major complications occurred in 8%, with no perioperative mortality. Mean operative time was 6.4 h and mean blood loss was 650 ml. At a median follow-up of 18.5 months, 76% of patients were alive and 72% were disease free. Median DFS and OS were 18.5 months. QoL improved significantly over time, with global health scores increasing from 69.5 to 80.8, and stoma-related QoL indices from 77.7 to 83.3%. With modern advances, PE offers a curative option with acceptable morbidity and improved quality of life. It should be actively considered in eligible patients rather than deferred in favor of palliative systemic therapies.