Purpose：The primary objective of this study was to comprehensively evaluate and compare the therapeutic efficacy of trastuzumab in combination with capecitabine plus cisplatin versus capecitabine plus cisplatin in the management of patients diagnosed with advanced human epidermal growth factor receptor 2 (HER2)-positive gastric cancer. Aiming to facilitate clinical decision-making and ultimately improving treatment outcomes for this specific patient population. Methods：A comprehensive computerized search was conducted across multiple databases, including Cochrane Library, Web of Science, PubMed, Embase, CNKI, CBM, VIP, and Wanfang to identify domestic and foreign clinical randomized controlled trials (RCTs), investigating the efficacy of trastuzumab in combination with capecitabine plus cisplatin for the treatment of patients with advanced HER2-positive gastric cancer. The search encompassed articles published from the inception of the databases until July 1, 2022. Results：This meta-analysis comprised 12 studies involving a total of 1199 patients diagnosed with advanced HER2-positive gastric cancer. The results revealed that the experimental group exhibited significantly higher rates of total effectiveness and control compared to the control group. Moreover, the experimental group showed a significant increase in median survival time compared to the control group. Additionally, the experimental group exhibited a significantly higher quality of life score and demonstrated improved prognosis in terms of carbohydrate antigen 19-9 (CA19-9) levels, with a lower recurrence rate. The experimental group showed a decrease in the stage of gastric cancer based on carbohydrate antigen 72-4 (CA72-4) levels and (CEA) levels compared to the control group.. Furthermore, the experimental group exhibited a notable enhancement in the therapeutic efficacy of vascular endothelial growth factor (VEGF) and a superior prognosis compared to the control group. Conclusion：Trastuzumab in combination with capecitabine plus cisplatin can be a preferred first-line treatment option for advanced HER2-positive gastric cancer, accompanying by a promising therapeutic efficacy.