Background and methods: Around 5-20% of patients who undergo surgery for advanced gastric cancer have peritoneal carcinomatosis. Peritoneal recurrence rate is 10-54%, which is associated with poor prognosis. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced gastric cancer is not clearly defined. We conducted a meta-analysis, in accordance with the PRISMA guidelines, of the clinical trials and high-quality non-randomized studies evaluating the role of HIPEC in AGC over the last 10 years. Clinical data including overall survival, recurrence-free survival, overall recurrence rate, peritoneal recurrence rate, and complications analyzed using RevMan5.4. Results: Six randomized controlled trials and 10 nonrandomized studies, comprising a total of 1700 patients were included. HIPEC was associated with significantly improved OS at 3 (OR 1.89, 95% CI 1.17-3.05) and 5 years (OR 1.87, 95% CI 1.29-2.71). HIPEC was associated with reduced overall recurrence (OR 0.49, 95% CI 0.31-0.80) and peritoneal recurrence (OR 0.22, 95% 0.11-0.47). HIPEC was not associated with increased complications. The occurrence of postoperative renal dysfunction was significantly higher in the HIPEC group (OR 3.94, 95% CI 1.85-8.38). Conclusion: HIPEC may improve survival rates and reduce recurrence rates in patients with AGC, without any significant increase in complications with a favorable impact on survival.