Ovarian cancer ranks as the second most prevalent genital malignancy in women and leads to higher rates of mortality among gynecological cancers, often diagnosed at advanced stages with extensive metastases. Historically, treatment for recurrent ovarian cancer (ROC) has focused on managing peritoneal metastases, typically through aggressive surgery followed by systemic chemotherapy. Recent advancements have included secondary cytoreductive surgery and the use of hyperthermic intraperitoneal chemotherapy (HIPEC), aimed at improving survival but still debated due to variable outcomes in prior studies. This study conclusively finds that factors such as radical surgery, good performance status, platinum sensitivity, a positive AGO score, and a low Peritoneal Carcinomatosis Index (PCI) significantly enhance survival rates for patients with ROC undergoing HIPEC. It also highlights the predictive importance of platinum resistance and the AGO score in determining outcomes. Given these results, there is a strong recommendation for further prospective studies to validate these findings and to refine the criteria for selecting patients suitable for HIPEC, aiming to improve the treatment strategies and survival outcomes in this patient group.