AIM:To evaluate the clinical outcomes and safety of anterior-and conventional-approach hepatectomy for patients with large liver tumors.METHODS:Pub Med,EMBASE,Google Scholar and the Cochrane Library databases were searched for randomized controlled trials(RCTs)and controlled clinical trials comparing anterior-approach hepatectomy(AAH)and conventional-approach hepatectomy(CAH).Two observers independently extracted the data using a spreadsheet and assessed the studies for inclusion.Studies that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed using either fixed effects or random effects models.RESULTS:Two RCTs and six controlled clinical trials involving 807 patients met the predefined inclusion criteria.A total of 363 patients underwent AAH and 444underwent CAH.Meta-analysis indicated that the AAH group had fewer requirements for transfusion(OR=0.37,95%CI:0.21-0.63),less recurrence(OR=0.57,95%CI:0.37-0.87),and lower mortality(OR=0.29,95%CI:0.13-0.63).There were no significant differences between AAH and CAH with regard to perioperative complications(OR=0.94,95%CI:0.58-1.51),intraoperative tumor rupture(OR=0.98,95%CI:0.40-2.40),or length of hospital stay(weighted mean difference=-0.17,95%CI:-2.36-2.02).CONCLUSION:AAH has advantages of decreased transfusion,mortality and recurrence compared to CAH.It is a safe and effective method for large cancers requiring right hepatectomy. AIM: To evaluate the clinical outcomes and safety of anterior-and conventional-approach hepatectomy for patients with large liver tumors. METHODS: Pub Med, EMBASE, Google Scholar and the Cochrane Library of databases were searched for randomized controlled trials (RCTs) and controlled clinical trials comparing anterior-approach hepatectomy (AAH) and conventional-approach hepatectomy (CAH). Two observers are extracted the data using a spreadsheet and assessed the studies for inclusion. Patients that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed either either fixed effects or random effects models .RESULTS: Two RCTs and six controlled clinical trials involving 807 patients with the predefined inclusion criteria. A total of 363 patients underwent AAH and 444underwent CAH. Meta-analysis indicating that the AAH group had fewer requirements for transfusion (OR = 0.37, 95% CI: 0.21-0.63), less recurrence (OR = 0.57, 95% CI: 0.37-0.87), and lower mortality (O R = 0.29, 95% CI: 0.13-0.63). Everyone no significant differences between AAH and CAH with regard to perioperative complications (OR = 0.94, 95% CI: 0.58-1.51), intraoperative tumor rupture % CI: 0.40-2.40), or length of hospital stay (weighted mean difference = -0.17, 95% CI: -2.36-2.02) .CONCLUSION: AAH has advantages of decreased transfusion, mortality and recurrence compared to CAH.It is a safe and effective method for large cancers requiring right hepatectomy.