Purpose: The main objective of the study is to evaluate the effect of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of naïve ovarian cancer women undergoing complete or near-complete cytoreduction by assessing the overall survival, the disease-specific survival, and the disease-free survival. The secondary objective is the identification of prognostic indicators of survival and recurrence of these patients. Patients—Methods: Retrospective study of treatment in naïve women with locally advanced ovarian cancer treated with cytoreductive surgery (CRS) and HIPEC and compared with those who were treated with cytoreduction alone. Clinicopathologic variables were correlated to overall survival, disease-specific survival, and disease-free survival using Kaplan–Meier method, and the multivariate Cox proportional hazards regression models. Results: 5- and 10-year overall survival, disease-specific survival, and disease-free survival rates were significantly higher in patients treated with CRS and HIPEC. These patients were 67% less likely to die from any cause (adjusted hazard ratio, aHR = 0.33, p = 0.001), 75% less likely to die from cancer (aHR = 0.25, p = 0.003), and 46% less likely to develop recurrence (aHR = 0.54, p = 0.041) compared to patients treated with CRS alone. Moreover, the poor performance status (aHR = 2.96, p < 0.001), the serous carcinomas (aHR = 0.14, p = 0.007), and the morbidity (aHR = 6.87, p < 0.001) were identified as independent indicators of poor overall survival. The degree of differentiation (aHR = 8.64, p = 0.003) was identified as the independent indicator of disease-specific survival (aHR = 4.13, p = 0.002), while the extent of peritoneal carcinomatosis (aHR = 2.32, p < 0.001) as the independent indicator of disease-free survival. Conclusions: Treatment in naïve patients with locally advanced ovarian cancer undergoing CRS plus HIPEC appears to have improved overall, disease-specific, and disease-free survival.

Background/Objectives: Hyperthermic intraperitoneal chemotherapy (HIPEC) was revealed as a promising adjunct to cytoreductive surgery (CRS) in the treatment of advanced epithelial ovarian cancer (EOC). This review evaluated the impact HIPEC had on survival outcomes, recurrence patterns and safety in patients that underwent HIPEC in conjunction with interval and secondary CRS for advanced and recurrent ovarian cancer. Methods: A thorough search was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar to identify relevant studies published until 1 January 2025. The studies were assessed for survival outcomes, recurrence patterns, safety, and quality of life. The risk of bias was evaluated using the ROB 2 tool for randomized and ROBINS-I for non-randomized articles. The results are presented narratively, highlighting key findings, comparing results and assessing inconsistencies and limitations. Results: HIPEC demonstrated significant improvements in progression-free survival (PFS) and overall survival (OS), particularly in cases with optimal cytoreduction (CC-0/CC-1). The recurrence patterns showed a reduction in peritoneal dissemination with HIPEC, although extraperitoneal recurrences were reported in some cases. Most studies reported comparable morbidity rates between HIPEC and non-HIPEC groups, with acceptable safety profiles. The variability in the HIPEC protocols and the limited quality-of-life and cost-effectiveness data were noteworthy limitations. Conclusions: HIPEC, when performed during interval or secondary CRS, offers survival benefits and can modify recurrence patterns in advanced EOC, although challenges related to protocol standardization, patient selection, and long-term outcomes persist. Future research should focus on multicenter trials with uniform protocols, long follow-up periods and patient-centered outcomes to further validate the role of HIPEC in clinical practice.

Background/Objectives: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may modify the prognostic impact of established clinical and surgical factors in advanced ovarian cancer. A retrospective study was conducted to identify independent predictors of survival, recurrence patterns and major postoperative complications in the HIPEC setting. Methods: In total, 265 women with advanced-stage ovarian cancer operated on between 2015 and 2019 were included. Patients were treated with CRS, with or without HIPEC. Patients’ characteristics, oncological and follow-up information were collected. Results: In total, 62.3% underwent primary CRS, and 39.2% received HIPEC, with complete or near-complete cytoreduction (CC-0/1) achieved in 85.6%. Major complications (≥grade III) were recorded in 16.6% of the patients. HIPEC, high peritoneal cancer index (PCI), and greater intraoperative blood loss were found to independently increase the odds of major postoperative complications, while prior surgery was the only independent predictor of local-regional recurrence. The median follow-up was 34 months, with a median progression-free (PFS) and overall survival (OS) of 26 and 77 months, respectively. Multivariable analysis identified systematic lymphadenectomy and serous histology as independent predictors for PFS and also for OS, with the addition of CC-3. Survival analysis with Kaplan–Meier curves revealed that CRS plus HIPEC was associated with significantly better OS, but not PFS, compared with CRS alone. Conclusions: Systematic lymphadenectomy, serous histology, and absence of macroscopic gross residual disease emerge as key independent favorable prognostic factors in the HIPEC era, while prior surgery adversely affects loco-regional control. CRS plus HIPEC improved OS in this specific regimen’s perfusion protocol but was associated with higher major postoperative complications, underscoring the need for careful patient selection.