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Introduction Long term outcomes have been reported in home parenteral support (HPS)-dependent patients with chronic intestinal failure (IF), but there are limited generalisable data on patient mortality and regaining nutritional autonomy rates that would help provide a meaningful prognosis for patients and clinicians. The primary objective of this systematic review and meta-analysis was to examine the evidence published up to 2025 on mortality and regaining nutritional autonomy rates.Methods A systematic database search was conducted up to 03.02.2025. Studies assessing mortality and regaining nutritional autonomy in adult patients with benign chronic IF receiving HPS were included. For clinical outcomes crude proportions were calculated and then meta-analysis was performed to calculate the proportion affected per year of follow-up and to summarize survival probabilities presented on Kaplan-Meier curves.Results A total of 4,992 records were found from searching databases; after removing duplicates, 3,411 records were screened, and 305 full-text documents were reviewed. Additionally, 64 records were identified from scanning the reference lists of initially included studies. Overall, 57 studies were included in the review. The meta-analysis showed that the overall mortality of patients with chronic IF was 8.0% per year of follow-up (95% CI 6.0 to 10.0%) or 33.5% over a mean of 49.02 months of follow-up. The summary of survival curves estimated pooled five- and ten-year survival rates from HPS initiation as 68.71% and 52.46%, respectively. The meta-analysis showed that nutritional autonomy was achieved in 35.3% of patients at a rate of 10.0% per year of follow-up (95% CI 7.0% to 14.0%). Overall, age, gastrointestinal anatomy and pathological conditions leading to IF were identified by multiple studies as potential factors associated with overall mortality and nutritional autonomy.Conclusions The study presents a new review and meta-analysis on mortality and the ability to regain nutritional autonomy in adults with chronic IF. These findings increase our understanding of this condition and provide useful baseline data for clinical decision-making and patient counselling.