Objectives <p>Systematic evaluation of the efficacy and safety of reduction surgery in asymptomatic unresectable advanced gastric cancer.</p> Materials and methods <p>PubMed, EMBASE, Cochrane Library and Web of Science were searched from database inception to 12 July 2024. The Cochrane Risk of Bias Assessment Tool and Newcastle-Ottawa Scale were used to evaluate the quality and analyze the bias of the randomized controlled and non-randomized controlled studies included in this study, and RevMan (Version 5.4) was used to perform the meta-analysis.</p> Results <p>A total of 5 studies were finally included, including 1 randomized controlled study and 4 retrospective studies. The cumulative sample size was 1717 cases, including 701 cases in the reduced surgery group and 1016 cases in the non-surgical treatment group. The results of the Meta-analysis showed that the reduced surgery group did not offer a survival benefit compared with the non-surgical treatment group in terms of 1-year, 3-year, and 5-year survival rates. The reduced surgery group had a longer median survival time than the non-surgical group by 11.58 months. The incidence rate, morbidity rate, and mortality rate of the reduced surgery group were 5.5% and 6.5% higher than those of the non-surgical group, respectively. The incidence of perioperative complications and death rate in the reduced surgery group were 15% and 4%, respectively; about 3% of patients might have complications of the primary foci during non-surgical treatment and need palliative surgical resection.</p> Conclusion <p>Current evidence suggests that in asymptomatic patients with unresectable advanced gastric cancer, reduced surgery with resection of the primary site does not result in a long-term survival benefit. We look forward to more high-quality randomized controlled trials to provide more substantial evidence to support clinical practice.</p>