Purpose Malignant peritoneal mesothelioma (MPM) is a rare and highly aggressive tumour involving the mesothelial lining of the peritoneum, usually secondary to asbestos exposure, although germline BAP-1 mutation can predispose to development of MPM. Prognosis is poor without treatment. Systemic therapy, whilst non-curative, can prolong overall survival (OS). Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS & HIPEC) is the preferred approach as it offers a chance of cure and offers the best survival outcomes. This study aims to report CRS & HIPEC outcomes for MPM at Royal Prince Alfred Hospital. Methodology A retrospective cohort study was performed on prospectively collected data from April 2017 to May 2023. Demographic, surgical and oncological data of consecutive patients undergoing CRS & HIPEC was analysed using SPSS Statistics for Windows (IBM Corp, NY, USA). Results There were 12 males (57%) patients with a median age of 63 years. 19 (91%) of patients had epithelioid subtype of MPM. The median peritoneal carcinomatosis index was 28 (range 3-39). Complete cytoreduction was achieved in 20 (95%) patients (12 (57%) CC-0 and 8 (38%) CC-1). Only one patient had significant residual disease (CC-3). Median disease free survival was 34.6 months and overall survival was 47.7 months (IQR 32.6 – 62.7). 6 and 15 patients received pre and post-operative systemic therapy respectively. Mean ICU stay was 5.3 days, and total length of stay 22.5 days. 18 (86%) patients had complications with majority being Clavien-Dindo 1 and 2. Conclusion The overall survival for patients undergoing CRS & HIPEC for MPM in our Australian institution experience was comparable with other centres worldwide at 47.7 months.