Recurrence rates and mortality in women with advanced ovarian cancer remain high, despite progress in therapeutic strategies and surgical techniques in the last decades. Peritoneal dissemination is a distinctive feature in the natural history of the disease and forms a target for hyperthermic intraperitoneal chemotherapy (HIPEC), complementary to (near) complete cytoreductive surgery (CRS). The high intraperitoneal concentration of chemotherapy under hyperthermic conditions increases penetration into tumor deposits and potentiates the cytotoxic effect. A recent randomized controlled trial demonstrated its evident survival benefit in front-line in a selected patient population, without incurring additional toxicity. Whether this survival benefit applies to women undergoing primary CRS is currently investigated. Several unanswered questions – e.g. open versus closed procedure, patient selection, and integration with subsequent therapies – need more research, ultimately leading to a uniform protocol and adoption into routine care, with the aim of improving survival outcomes for women with advanced ovarian cancer.