AIM To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach.METHODS We comprehensively performed an electronic search of Pub Med, EMBASE, and the Cochrane Library for randomized controlled trials(RCTs) or controlled clinical trials(CCTs) published between January 2000 and May 2017 concerning the anterior approach(AA) and the conventional approach(CA) to right hepatectomy. Studies that met the inclusion criteria were included, and their outcome analyses were further assessed using a fixed or random effects model.RESULTS This analysis included 2297 patients enrolled in 16 studies(3 RCTs and 13 CTTs). Intraoperative blood loss [weighted mean difference =-255.21; 95% confidence interval(95%CI):-371.3 to-139.12; P < 0.0001], intraoperative blood transfusion [odds ratio(OR) = 0.42; 95%CI: 0.29-0.61; P < 0.0001], mortality(OR = 0.59; 95%CI: 0.38-0.92; P = 0.02), morbidity(OR = 0.77; 95%CI: 0.62-0.95; P = 0.01), and recurrencerate(OR = 0.62; 95%CI: 0.47-0.83; P = 0.001) were significantly reduced in the AA group. Patients in the AA group had better overall survival(hazard ratio [HR] = 0.71; 95%CI: 0.50-1.00; P = 0.05) and disease-free survival(HR = 0.67; 95%CI: 0.58-0.79; P < 0.0001) than those in the CA group.CONCLUSION The AA is safe and effective for right hepatectomy for large hepatocellular carcinoma and could accelerate postoperative recovery and achieve better survival outcomes than the CA. AIM To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach. METHODS We comprehensively performed an electronic search of Pub Med, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) or controlled clinical trials (CCTs published between January 2000 and May 2017 concerning the anterior approach (AA) and the conventional approach (CA) to right hepatectomy. Studies that met the inclusion criteria were included, and their outcome analyzes were further assessed using a fixed or random effects model. RESULTS This analysis included 2297 patients enrolled in 16 studies (3 RCTs and 13 CTTs). Intraoperative blood loss [weighted mean difference = -255.21; 95% CI: 371.3 to -139.12; P <0.0001] 95% CI: 0.29-0.61; P <0.0001], mortality (OR = 0.59; 95% CI: 0.38-0.92; P = 0.02) and morbidity (OR = 0.77; 95% CI: 0.62-0.95; P = 0.01), and re Patients in the AA group had better overall survival (hazard ratio [HR] = 0.71; 95% CI: 0.50- 1.00; P = 0.05) and disease-free survival (HR = 0.67; 95% CI: 0.58-0.79; P <0.0001) than those in the CA group. CONCLUSION The AA is safe and effective for right hepatectomy for large hepatocellular carcinoma and could accelerate postoperative recovery and achieve better survival outcomes than the CA.