Locally advanced malignant tumors of the small pelvic organs are characterized by difficulty in differential diagnosis and pose specific problems for a cancer surgeon. Objective: to improve surgical techniques and to enhance the efficiency of treatment in patients with malignant tumors of the small pelvic organs (rectum, female genitals, urinary system, and retroperitoneal space) in whom the lesion was locally advanced. Subjects and methods. The results of combined treatment were analyzed in 712 patients who had been treated for locally advanced malignant tumors of the small pelvis. The common sites for primary tumors in locally advanced malignancies of the small pelvic organs were the rectum (85.4%) and female genitalia (12.4%); the less commonly sites were the urinary tract (0.4%) and retroperitoneal space (1.8%). The simultaneous involvement of two and three organs in the process was established in 77.2 and 14.8% of the patients, respectively. All the patients underwent surgical interventions: radical combined surgery (a study group of 542 patients); combined cytoreductive surgery (a comparison group of 94 patients); 76 patients had symptomatic surgery, such as a colostomy, bypass. Results. The 5-year survival rates were 48.7±0.6% after radical extended and combined interventions (R0) and 15.6±1.0% after cytoreductive ones (R1). These rates were not recorded after symptomatic surgery even in combination with radiochemotherapy. Conclusion. Radical surgery in patients with locally advanced tumors of the small pelvic organs (rectum, female genitals, urinary system, and retroperitoneal space) allows the acceptable rates of postoperative complications, mortality, and overall survival to be achieved.