Objective: To evaluate the clinical outcomes of elderly patients with advanced ovarian cancer who did not undergo surgery and received chemotherapy with or without maintenance therapy. Methods: We retrospectively analyzed the clinical data of 15 patients with advanced high-grade serous ovarian cancer who were treated at our hospital between 2018 and 2023. These patients either had multiple comorbidities or refused surgery. Data collected included patient demographics, treatment regimens, chemotherapy cycles, clinical response, progression-free survival (PFS), and overall survival (OS). Results: The median age of the patients was 73 years (range, 50-86 years). Fourteen patients received platinum-based chemotherapy combined with paclitaxel or liposomal doxorubicin, with or without bevacizumab, for 3 to 6 cycles. Twelve patients who achieved disease control received PARP inhibitor maintenance therapy. The overall response rate (ORR) was 80.0%, or 12/15 patients achieved partial response (PR); nobody achieved complete response. The disease control rate (DCR) was 100%. The median PFS1 was 19.0 months (95% CI, 11.85-26.15), and the median PFS2 was 10 months. The 3-year OS rate was 65.2%, with a median OS of 57.0 months (95% CI, 13.00-100.99). Conclusions: Chemotherapy with or without bevacizumab, followed by PARP inhibitor maintenance therapy, is a viable alternative for elderly or surgically ineligible patients with advanced ovarian cancer. The findings of this study should be considered exploratory and require validation through large-scale studies.