Currently no standard treatment for patients with advanced hepatocellular carcinoma (HCC), and available literature assessing octreotide's treatment effect on HCC reports discordant results. The primary purpose of this study was to evaluate the effect of octreotide therapy on patient survival. The secondary endpoints were to assess tumor response, quality of life and adverse effects. PUBMED, MEDLINE, OVID and SPRINGER databases were searched through January 2009. Randomized controlled trials that compared octreotide treatment with placebo or no treatment were selected. Finally, four randomized controlled trials (three of which were high quality trials) published in 1998 or later with a total of 373 patients were included in this review. Because a significant clinical heterogeneity existed between the included trials, making meta-analysis inappropriate; only a narrative systematic review was performed. Of the three high-quality trials, only one(126 patients) reported octreotide could improve survival and quality of life of HCC patients, whereas the other two(189 patients) suggested octreotide did not have survival benefit in HCC; moreover, none of the three trials indicated that octreotide has significant beneficial effect on tumor regression or decrease of tumor mass. Nonetheless, serious adverse effects were not reported in these included trials. In this review, results from included randomized controlled trials demonstrated no clear benefit of octreotide therapy in advanced HCC patients. In order to detect a realistic treatment advantage, further larger well-designed multicenter randomized trials will have to be conducted.