Abstract
<title>Abstract</title> <p> Background. Recent trials showed that the use of hyperthermic intraperitoneal chemotherapy (HIPEC) beside cytoreductive surgery (CRS) in patients with ovarian cancers (OC) may decrease the mortality rates, but the results are still unclear. So, we aim to investigate the long-term survival and progression rates in OC patients who have undergone HIPEC. Methods. Recent randomized controlled trials (RCTs) that compare the use of HIPEC plus CRS vs. CRS alone in OC patients were retrieved from electronic databases up to 20 December 2024, with an updated search performed on 8 August 2025. The hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were used to represent the pooled estimate. Results. A total of 10 RCTs (1,508 patients) were included in the analysis. The analysis showed that the use of HIPEC plus CRS was associated with similar overall survival (OS) (HR: 0.82, 95% CI [0.65 to 1.01], <italic>log-rank p-value</italic> = 0.09), and progression-free/disease-free survival (PFS/DFS) (HR: 0.80, 95% CI [0.66; 1.02], <italic>log-rank p-value</italic> = 0.06) compared to CRS alone at 10 years of follow-up. Subgroup analysis showed that the risk of OS and PFS was lower after applying interval surgery with neoadjuvant chemotherapy for primary tumors, but the incidence of mortality and progression was similar between the two groups after primary surgery or in recurrent tumors. Conclusion. Among patients with OC who underwent interval surgery, adding HIPEC to CRS had a higher OS and lower PFS/DFS, unlike primary surgery or in recurrent OC, compared with CRS alone. </p>