Peritoneal surface malignancies (PSMs) have historically been associated with limited treatment options and poor prognosis. However, advancements in perioperative systemic chemotherapy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) have significantly improved clinical outcomes. PSMs primarily result from the spread of intra-abdominal neoplasia, with colorectal, ovarian, and gastric cancers being the most common contributors. The peritoneal microenvironment plays a crucial role in the development and progression of PSMs, with fibroblasts contributing to tumor growth, progression, and therapy resistance. Peritoneal metastasis-associated fibroblasts (MAFs) exhibit high heterogeneity, with immune-regulatory cancer-associated fibroblasts (CAFs) being the most prevalent subtype. Other major subtypes include myofibroblastic CAFs (myCAFs) and matrix CAFs (mCAFs). MAFs are believed to originate from mesothelial cells, submesothelial fibroblasts, pericytes, endothelial cells, and omental-resident cells. Understanding the interactions between MAFs and the tumor microenvironment is crucial for developing targeted and local therapies to improve patient outcomes.Peritoneal surface malignancies (PSMs) have historically been associated with limited treatment options and poor prognosis. However, advancements in perioperative systemic chemotherapy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) have significantly improved clinical outcomes. PSMs primarily result from the spread of intra-abdominal neoplasia, with colorectal, ovarian, and gastric cancers being the most common contributors. The peritoneal microenvironment plays a crucial role in the development and progression of PSMs, with fibroblasts contributing to tumor growth, progression, and therapy resistance. Peritoneal metastasis-associated fibroblasts (MAFs) exhibit high heterogeneity, with immune-regulatory cancer-associated fibroblasts (CAFs) being the most prevalent subtype. Other major subtypes include myofibroblastic CAFs (myCAFs) and matrix CAFs (mCAFs). MAFs are believed to originate from mesothelial cells, submesothelial fibroblasts, pericytes, endothelial cells, and omental-resident cells. Understanding the interactions between MAFs and the tumor microenvironment is crucial for developing targeted and local therapies to improve patient outcomes.