Objectives: Hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly recognized as an effective addition to cytoreductive surgery in advanced ovarian cancer, particularly in patients who respond to platinum-based chemotherapy. Methods: A systematic review of phase III randomized controlled trials testing the role of HIPEC in ovarian cancer was performed, according to the PRISMA guidelines. Results: Seven randomized controlled trials were included. Data of 1252 patients with ovarian cancer were examined: 630 and 622 having surgery plus HIPEC and surgery alone, respectively. This review critically evaluates the role of HIPEC in various clinical scenarios, including primary and interval debulking surgery and secondary cytoreduction. Evidence from key clinical trials is summarized, focusing on its effects on progression-free and overall survival. Important factors such as patient selection, chemotherapy regimens, technical procedures, and perioperative care are examined. Potential side effects (including renal toxicity, gastrointestinal injury, and delayed recovery) are discussed. The review also assesses cost-effectiveness and integration of HIPEC into multidisciplinary treatment plans. Emerging approaches, such as combining HIPEC with targeted therapies and personalized treatment strategies, are explored. Conclusions: While HIPEC offers a promising therapeutic advance, further high-quality studies are needed to refine its use and assess its role in earlier stages of disease. This review aims to inform clinical decisions and support future research in the evolving management of ovarian cancer.
