Background Limb‐salvage surgery with vascular reconstruction is the current standard treatment when sarcoma involves major vessels of the lower extremity. However, the low incidence of sarcoma and rarity of limb‐salvage surgery are limiting factors for the reliable study of limb‐salvage surgery. Therefore, a systematic review was conducted to establish better management of lower extremity sarcoma based on currently available evidence. Methods A systematic review and meta‐analysis of data on limb‐salvage surgery with vascular reconstruction for lower extremity sarcoma were conducted using MEDLINE through PubMed, Scopus, CINARL, and Cochrane Database of Systematic Reviews. Overall limb‐salvage rate was the primary outcome, and rates of perioperative complication and arterial patency were secondary outcomes. Results Among the 271 patients (18 studies) included in this study, 69.4% underwent arterial reconstruction with autologous graft, 22.0% underwent synthetic graft, and 8.6% underwent other reconstructive methods. Pooled overall limb‐salvage rate was 89.8% [95% confidence interval (CI), 85.0–93.1%] after a mean follow‐up of 19–74.7 months. Pooled overall perioperative complication and arterial patency rates were 49.5% (95% CI, 42.8–56.2%) and 85.4% (95% CI, 79.5–89.9%), respectively. Conclusions Current evidence suggests that limb‐salvage surgery with vascular reconstruction has a high limb‐salvage rate; however, the high perioperative complication rate remains problematic. Early and appropriate interventions are required to optimize the complications of limb‐salvage surgery.