Efficacy of hyperthermic intraperitoneal chemotherapy in advanced ovarian cancer: a bibliometric analysis and updated meta-analysis.

[BACKGROUND] Advanced ovarian cancer is the most lethal gynecologic malignancy, and the clinical value of hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. This study aimed to define the efficacy of HIPEC by integrating the highest level of evidence and to delineate the research landscape of the field.

[METHOD] We conducted a systematic search of multiple databases, including randomized controlled trials (RCTs) up to June 2025, for a meta-analysis and bibliometric review. Study selection was guided by the PICOS framework to define eligibility criteria. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Statistical pooling for the meta-analysis was executed with the Review Manager, and bibliometric analysis was performed and plotted by Bibliometrix and VOSviewer software.

[RESULT] Nine RCTs (1621 patients) were included in the meta-analysis. HIPEC significantly improved OS in both primary (HR = 0.71[0.60 to 0.84], P < 0.001) and recurrent ovarian cancer (HR = 0.73[0.58 to 0.92], P = 0.008), and improved PFS in primary cancer (HR 0.74, 95 % CI 0.61-0.91). Subgroup analysis revealed that the greatest benefit was observed in patients who received HIPEC after neoadjuvant chemotherapy (NACT) and when the open technique was used. The bibliometric analysis revealed an annual rise in the number of studies in this field, with the United States and China making leading contributions.

[CONCLUSION] This meta-analysis indicated HIPEC had a positive prognosis for advanced ovarian cancer, especially for primary ovarian cancer and patients undergoing neoadjuvant chemotherapy. The bibliometric analysis highlighted the need for more large-sample and high-quality clinical trials to establish higher-level evidence in subsequent research.