Medical management with combinations of cytotoxic chemotherapy, and/or biological agents, has resulted in an unprecedented median survival >20 months in patients with Stage IV colorectal cancer. The management of disease limited to the peritoneal cavity has been controversial and at the present time, there is no published data that outlines the impact of these new therapeutic regimens when given to patients with colorectal cancer with metastatic disease confined to the peritoneum. Over the last 5 years, an increasing number of international treatment centers have published their prospective results using cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of peritoneal surface malignancies of colorectal origin and have shown that good long-term results can be achieved with a complete cytoreduction and HIPEC. However, most of the surgical data comes from Phase II studies from single institutions and there is a wide range on inclusion/exclusion criteria, drugs, temperatures and methods of delivering the heated chemotherapy. This manuscript will analyze and discuss the results of a group of health care providers trying to achieve a consensus statement in the management of this group of patients.