Peritoneal surface malignancies may now be approached with curative intent using a strategy of cytoreductive surgery combined with intraperitoneal chemotherapy. Complete cytoreduction to tumor nodules less than 2.5 mm is considered critical to the efficacy of the local chemotherapy and achieving complete cytoreduction impacts long-term survival. However, this procedure results in significant morbidity with frequent surgical complications. Meticulous technique must be used to limit anastomotic complications, operative time, and blood loss. This review summarizes the major issues surrounding visceral resection and peritonectomy during cytoreductive surgery. Problem areas, which merit special attention, are described, and recommendations are made with regard to surgical technique.