Background <p>Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is used as an effective multimodal treatment option for patients with peritoneal malignancies. In this retrospective study, the anesthetic management of CRS + HIPEC procedures performed in our hospital between 2020 and 2024 and the postoperative course of the patients were investigated.</p> Methods <p>The present study included 22 patients who underwent CRS + HIPEC at our hospital. Preferred solutions for perioperative fluid management were balanced crystalloid, colloid and albumin. The mean duration of surgery was 326 and the mean duration of anesthesia was 344&#xa0;min. 72.7% of the patients were female, and 27.3% were male, and the mean age was 58.6 years. ASA 3 score was found in 81.8% of the patients. While 68.2% of the patients did not receive preoperative chemotherapy, 31.8% received chemotherapy.</p> Results <p>In the intraoperative period, the mean body temperature increased to 38.1&#xa0;°C, and 6568 mL of crystalloid and 1325 mL of colloid were used for fluid management. The most prevalent metabolic alterations observed in the postoperative period were hypocalcemia (81.2%), hypokalemia (45.5%) and hyperglycemia (36%). A significant increase in lactate level (1.85 ± 1.93 mmol/L) and a decrease in bicarbonate level (4.12 ± 4.66 mmol/L) were observed after HIPEC. While 22.7% of the patients died in the postoperative period, 77.3% were discharged. Liberal fluid management strategies were employed; however, in recent cases, targeted fluid management has been introduced.</p> Conclusion <p>It is imperative to emphasize that individualized fluid management and advanced monitoring during CRS + HIPEC procedure are critical in maintaining hemodynamic balance and reducing complications.</p> Clinical trial registration <p>The Study was registered in clinicaltrials.gov (trial ID: NCT06398678 on 03/05/2024).</p>