Background <p>This study was aimed to evaluate the impact of multivisceral resection (MVR) on the oncologic outcomes of patients with locally advanced colorectal cancer.</p> Methods <p>We conducted a retrospective review of patients who underwent surgical resection between 2011 and 2020. Patients were divided into two groups: the MVR group and the standard resection group. Prognostic factors were compared, and the effect of MVR on oncologic outcomes was assessed.</p> Results <p>Among 625 patients, 108 underwent MVR. The MVR group showed a significantly lower rate of lymph node metastasis (51.9% vs. 72.5%, <i>p</i> &lt; 0.001), lymphovascular invasion (25.9% vs. 42.8%, <i>p</i> = 0.001), and perineural invasion (45.4% vs. 73.2%, <i>p</i> &lt; 0.001) compared to the standard resection group. Postoperative complications were more frequent in the MVR group (57.4% vs. 26.9%, <i>p</i> &lt; 0.001). Three-year disease-free survival (68.6% vs. 62.7%, <i>p</i> = 0.743) and overall survival (OS) (80.9% vs. 85.0%, <i>p</i> = 0.290) were comparable between the two groups. Multivariable analysis identified lymph node metastasis, perineural invasion, R2 resection, and absence of adjuvant chemotherapy as independent poor prognostic factors for OS.</p> Conclusions <p>The MVR group showed a significantly lower rate of lymph node metastasis and comparable oncologic outcomes. Therefore, when adjacent organ invasion is suspected, an aggressive en-bloc MVR should be considered to achieve radical resection.</p>