Cytoreductive surgery (CRS) and HIPEC are fine examples of surgical innovation and commitment to improving patient outcomes. Prior to the 1900s, peritoneal malignancy was considered a terminal condition with an abysmal prognosis. Any surgical intervention was reserved for compassionate palliation of symptoms. Today however, CRS is firmly established in the treatment of peritoneal carcinomatosis. The journey of CRS begins in 1934 when Meigs suggested excision of ovarian cancer to enhance the effect of post-operative chemotherapy. Three decades later, a case series by Munnel reported significant survival in ovarian cancer patients who underwent resection of the omentum, appendix and localised peritoneum in addition to hysterectomy/oophorectomy. In 1977, Spratt developed a device to deliver hyperthermic drugs into the peritoneal cavity of animals, then two years later treated his first human patient with pseudomyxoma peritonei using it. In 1987, a phase I trial reported the antineoplastic activity of intraperitoneal cisplatin. The peritoneal carcinomatosis index, now a mainstay in surgical textbooks, was developed in 1990 to more accurately describe disease burden which is linked to outcome. In 1995, Sugarbaker published a formal description of peritonectomy. In the same year, the first peritonectomy unit in Australia was established at St George Hospital Sydney. The last three decades has seen the foundation of a dedicated society, international surgical standardisation, and development of evidence-based peri-operative care. The balance of improving both quality of life and overall survival is a challenge, but surgeons remain at the forefront of ongoing innovation.