Objective <p>To evaluate the impact of anatomy-based planning (ABP) and individualized electrode array selection on cochlear implant outcomes, and to compare the effectiveness of precision-guided approaches versus conventional clinician-driven programming strategies.</p> Data sources <p>Systematic searches of PubMed, Web of Science, Scopus, and Embase were conducted for studies published between January 2000 and June 2025.</p> Review methods <p>This meta-analysis followed PRISMA 2020 guidelines. Eleven studies involving 291 post-lingually deafened adults were included. Only studies utilizing anatomy-based planning tools with quantifiable auditory and speech outcomes were analyzed. Data synthesis was performed using a fixed-effects model, and subgroup analyses were conducted based on surgical approach and outcome type.</p> Results <p>All included studies demonstrated superior outcomes with ABP compared to conventional planning, with odds ratios ranging from 1.5 to 7.0. Pooled analysis revealed significant benefits in both speech-related (OR = 1.93, 95% CI: 1.56–2.40) and auditory/music-related outcomes (OR = 2.38, 95% CI: 1.98–2.86). Subgroup analysis confirmed consistent advantages of ABP across both round window and cochleostomy approaches. No study reported adverse intraoperative events directly attributable to ABP. Individualized electrode array selection based on cochlear duct length and angular insertion depth improved frequency-place alignment and auditory perception.</p> Conclusion <p>Anatomy-based planning significantly enhances cochlear implantation outcomes by optimizing electrode positioning, minimizing frequency-place mismatch, and improving speech and auditory performance. The integration of precision imaging and individualized planning tools represents a promising step toward personalized otologic surgery.</p> Level of evidence <p>Level III (Meta-analysis of non-randomized and randomized controlled trials).</p>