Favorable oncological outcomes have been reported in several trials with the 
introduction of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal 
Chemotherapy (HIPEC) in the treatment of Advanced Epithelial Ovarian Cancer 
(EOC). However most of the studies testing the combined approach are 
observational and have been conducted in inhomogeneous series so that the 
evidence supporting the performance of this combined treatment is still poor. 
Median Overall and Disease Free Survivals of up to 64 months and 57 months, 
respectively have been reported. Although a rate of morbidity of up to 40% has 
been observed in some series the CRS + HIPEC continues to gain an increased 
popularity. Several prospective randomized trials are ongoing using the 
procedure in various time points of the disease. In this review several issues 
such as the impact of cytoreduction and residual disease (RD) on outcomes as 
well as the role of HIPEC will be updated from the literature evidence. Some 
controversial points HIPEC related will also be discussed. Recent experiences 
regarding the introduction of a more aggressive surgical approach to upper 
abdomen to resect peritoneal carcinomatosis (PC) allowed increased rates of 
optimal cytoreduction and has demonstrated an apparent better outcome. This 
evidence associated with the positive results phase III trial testing 
normothermic intraperitoneal as first-line chemotherapy is guiding some 
investigators to propose the CRS + HIPEC in the primary setting. Several 
prospective phase II and III trials have recently been launched to validate the 
role of the combined treatment in various time points of disease natural 
evolution.