This study evaluated the therapeutic effects of open and minimally invasive surgeries in patients with drug-resistant epilepsy.This study systematically searched electronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, subsequent open-label expansion studies, prospective studies and retrospective studies on surgical procedures for patients with drug-resistant epilepsy. The main outcome was seizure-free status. A one-arm meta-analysis integrating data from all studies was performed to evaluate the treatment outcomes at multiple time points.A total of 62 studies were included, representing 5958 individuals who received five treatment regimens. The analysis results indicate that anterior temporal lobectomy and selective amygdalohippocampectomy is still the best choice for treating drug-resistant mesial temporal lobe epilepsy epilepsy in adult epilepsy patients. During the overall follow-up period, the seizure free rates for anterior temporal lobectomy, selective amygdalohippocampectomy, laser interstitial thermal therapy, radiofrequency thermocoagulation, and gamma knife surgery were 62%, 70%, 58%, 47%, and 57%, respectively.Among the five surgical methods included in this study, anterior temporal lobectomy and selective amygdala hippocampal resection seem to have more advantages in postoperative epilepsy control compared to laser interstitial hyperthermia, radiofrequency thermocoagulation, and gamma knife surgery. Each surgical treatment method has its unique focus, and when choosing a specific method, it is necessary to consider the patient's specific situation, the type and location of epileptic seizures, and possible side effects. Treating physician will develop personalized treatment plans based on these factors to maximize treatment effectiveness and reduce risks.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.