Background and Aims: Three-dimensional visualization helps the surgeons further directly observe the vascular network inside the liver and categorize the variations as well as calculate the resection volume of the liver and future liver remnant. The aim of this study was to evaluate the application value of three-dimensional visualization technique in liver cancer surgery. 
Methods: The clinical trials and observational studies concerning the application of three-dimensional visualization technique in the surgical operation of liver cancer were collected by systematically searching the databases at home and abroad in the time period from the inception of the databases to October 2019. The literature screening, data extraction and quality assessment were conducted by two independent reviewers. Meta-analysis was performed by using Revman5.3 software. 
Results: Fifteen studies were finally included, involving 1 283 patients, of whom 647 cases underwent preoperative evaluation with three-dimensional imaging (three-dimensional group) and 636 cases underwent preoperative evaluation with two-dimensional images (two-dimensional group). The results of Meta-analysis showed that in three-dimensional group compared with two-dimensional group, the radical resection rate (R0 resection rate) was increased (OR=3.05, 95% CI=1.42–6.55, P=0.004), the intraoperative blood loss was reduced (MD=–83.87, 95% CI=–104.68––63.05, P<0.05), the incidence of postoperative complications was decreased (OR=0.52, 95% CI=0.36–0.76, P<0.05), and the difference between the predicted resected liver volume and the actual resected liver weight was lessened (MD=–103.25, 95% CI=–173.24––33.26, P<0.05); there were no significant differences in operative time (MD=–2.03, 95% CI=–10.23–6.17, P>0.05) and length of hospital stay (MD=–1.10, 95% CI=–2.52–0.32, P>0.05) between the two groups.
Conclusion: The application of three-dimensional visualization technique in liver tumor surgery can improve the R0 resection rate, reduce the surgical injury and decrease the occurrence of postoperative complications, which may be related to its clear, accurate and direct display and measurement of the liver and targets. Therefore, compared to the traditional imaging technology, the application of three-dimensional visualization technique can improve the safety of liver surgery, and has important application value in surgical practice.