Background – Rural Australians typically encounter disparities in healthcare access, leading to adverse health outcomes, delayed diagnosis, and reduced QoL parameters. These disparities may be exacerbated in advanced malignancies, where treatment is only available at highly specialised centres with appropriate multidisciplinary expertise. Thus, this study aims to determine the association between patient residence on oncological, surgical, and QoL outcomes, following cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC). Methodology – A retrospective analysis was conducted on consecutive CRS and HIPEC patients at Royal Prince Alfred Hospital from 2017-2022. Based on their postcode, patients were stratified into metropolitan and regional. Data encompassing demographics, oncological, surgical, and QoL outcomes were compared. Results – Among the 317 patients, 228 (72%) were metropolitan and 89 (28%) regional. Metropolitan patients presented higher rates of recurrence (61.8% vs. 40.0%, p=0.014), and shorter overall mean survival (3.8 years [95% CI: 3.44-4.09] vs. 4.2 years [95% CI: 3.76-4.63], p=0.019) compared to regional patients. No other statistically significant differences were observed in oncological, surgical and QoL outcomes. Conclusions – Most oncological, surgical, and QoL parameters did not differ by geographical location of patients undergoing CRS and HIPEC for peritoneal malignancies at a high-volume quaternary referral centre. Observed differences in recurrence and survival may be attributed to the selective nature of surgical referrals and variable follow-up patterns. Future research should focus on characterising referral pathways and its influence on post-operative outcomes.