More treatments with pressurized intraperitoneal aerosol chemotherapy (PIPAC) lead to better survival outcomes for patients with unresectable peritoneal surface malignancies (PSMs).

• Patients receiving 3 or more PIPAC procedures showed significantly improved survival.
• Disease progression (56%) was the main reason for stopping treatment, signaling the need for ongoing evaluation of therapy effectiveness.

Surgeons should consider the number of PIPAC treatments when evaluating patient prognosis and plan for potential progression management strategies.

• Initiating PIPAC in a timely manner may enhance patient outcomes, particularly for those with specific PSM origins.