ObjectiveAt present, pancreatic cancer (PC) has a high morbidity and mortality rate and a poor prognosis. The aim of this article was to study the efficacy and safety of apatinib combined with radiotherapy in the treatment of advanced PC.MethodsThe PubMed, Cochrane Library, Embase, Wanfang, CNKI, VIP, and CBM databases were searched by computer to identify studies on the application of apatinib in patients with advanced PC. The patients in the included study were divided into an observation group (apatinib combined with radiotherapy) and a control group (radiotherapy only), and meta-analysis was performed for each outcome with Revman 5.4 software. This study was successfully registered on the PROSPERO website, and the registration number is CRD: 42,022,384,056 (available athttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=384056).ResultsA total of 7 randomized controlled trials (RCTs) with 428 patients were included, including 215 in the observation group and 213 in the control group. Compared with the control group, the observation group showed a greater objective response rate [OR = 3.26, 95% CI (2.18, 4.87),P< 0.0001], disease control rate [OR = 5.04, 95% CI (3.12, 8.12),P< 0.0001], complete response rate [OR = 3.87, 95% CI (1.51, 9.88),P= 0.005], and partial response rate [OR = 2.43, 95% CI (1.63, 3.61),P< 0.001], The 1-year survival rate [OR = 2.39, 95% CI (1.15, 4.96),P< 0.05], 2-year survival rate [OR = 2.41, 95% CI (1.03, 5.61),P< 0.05], progression-free survival time [MD = 1.17, 95% CI (0.37, 1.96),P< 0.05], overall survival time [MD = 1.47, 95% CI (0.13, 2.80),P< 0.05], while the stability rate [OR = 1.14, 95% CI (0.72, 1.81),P= 0.58] and various complications were not significantly different between the two groups.ConclusionApatinib combined with radiotherapy was more effective than radiotherapy alone in the treatment of advanced pancreatic cancer (PC), and apatinib had acceptable safety. However, since our study was limited by the quantity and quality of the included studies, we look forward to more large-sample, multicentre, and high-quality RCTs in the future to verify the conclusions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12957-023-03055-0.