OBJECTIVES:  Percutaneous microwave ablation (pMWA) is a highly prevalent therapy to treat primary or metastatic liver cancer patients in China. However, the clinical safety and effectiveness of MWA in treating large liver lesions (LLL) >3cm are debatable. The objective of this meta-analysis was to retrospectively evaluate the clinical safety and effectiveness of pMWA for Chinese patients with LLL. METHODS:  A systematic search of the MEDLINE, Embase, Cochrane library, CNKI and WanFang databases using relevant keywords for liver, hepatocellular, carcinoma, cancer, tumor, percutaneous, ablation and microwave was performed. Only studies on Chinese patients were included. Meta-analysis was conducted using non-comparative binary data in RevMan Software for the following variables: technical success rate (TSR), local recurrence rate (LRR) and 1-year survival (1YS). The data type was generic inverse variance, and random-effects model was used. All statistics are mean (95% CI). RESULTS:  14 studies, including 1,035 patients with primary or metastatic LLL, were analyzed. The TSR was 67% (50%-84%). Subgroup analysis showed a TSR of 96% (94%-99%) in patients with lesion size 3-5cm, while the rate was 60% (38%-83%) in patients with lesions>5cm. 29% (10%-47%) of patients with LLL had local recurrence. The LRR of patients with lesion 3-5cm and above 5cm were 27% (9%-64%) and 41% (22%-60%) respectively. The 1YS was 84% (77%-91%) with 89% (86%-93%) in the 3-5cm group and 62% (52%-71%) in the >5cm group. 8% (3%- 14%) of patients experienced major complications (e.g. liver abscess) post-operatively. The post-operative complication rate was 3% (1%-5%) in 3-5cm patients, and 12% (6%-18%) in the >5cm group. CONCLUSIONS:  The clinical safety and effectiveness of pMWA drops significantly in the treatment of Chinese patients with primary or metastatic liver cancer when the size of lesion increases from 3–5cm to >5cm. New technology should address these unmet needs in large lesion ablation