This study is a systematic review and meta-analysis comparing the efficacy of adjuvant therapies in patients with hepatocellular carcinoma (HCC) with high-risk factors for recurrence after hepatectomy. Data from 45 trials involving 8,409 patients were pooled from PubMed, Embase, and Web of Science databases through September 7, 2024. Overall survival (OS) and disease-free survival (DFS) were examined using combined hazard ratios (HRs) and 95% confidence intervals (CIs). Five different therapies were included: TACE, TKIs, RT, HAIC-FOLFOX, and others. TACE, TKI, RT, and HAIC-FOLFOX improved outcomes and reduced the risk of recurrence. RT was the most effective on DFS (HR = 0.31, 95% CI: 0.18-0.52), followed by TKI (HR = 0.48, 95% CI: 0.36-0.63). RT was most effective on OS (HR = 0.31, 95% CI: 0.19-0.50), followed by TKI (HR = 0.50, 95% CI: 0.38-0.66). RT proved to be the most effective adjuvant regimen.