BACKGROUND: Accurate preoperative determination of tumor depth is a major concern in colorectal cancer. Assessment of tumor depth can influence the treatment strategy for colorectal cancer, but there is currently no universal diagnostic standard. This review sought to evaluate the diagnostic performance of computed tomography (CT) colonography for tumor infiltration depth in colorectal cancer. METHODS: The PubMed, Scopus, and Cochrane Central Register of Controlled Trials databases were searched to identify studies that compared the tumor depth using CT colonography with that determined using pathological assessment. Relevant data were extracted from the eligible studies by two review authors working independently. Any disagreement was resolved by discussion. The quality of the studies was assessed using the QUADAS-2 tool. The diagnostic performance of CT colonography for tumor depth in colorectal cancer was evaluated by meta-analysis using sensitivity and specificity values and diagnostic odds ratios. RESULTS: The systematic literature search identified 16 eligible studies. The pooled sensitivity and specificity values and diagnostic odds ratios were 97.8% (95% confidence interval [CI] 88.1-99.6), 76.4% (95% CI 59.9-87.5), and 142.6 (95% CI 20.0-1071.0) for T2 invasion, 97.7% (95% CI 92.1-99.3), 83.5% (95% CI 75.9-89.0), and 212.1 (95% CI 50.6-888.1) for T3 invasion, and 84.9% (95% CI 61.7-95.1), 97.5% (95% CI 93.2-99.1), and 219.5 (95% CI 37.8-1273.6) for T4 invasion, respectively. CONCLUSIONS: CT colonography was found to have high diagnostic performance and was useful for determining tumor depth in colorectal cancer.