Background and Aims Three-dimensional (3D) visualization technology utilizes computers to reconstruct 3D images from CT and/or MRI examination, which provides an intuitive and clear display of the morphology and spatial distribution of structures such as the liver, pancreas, bile ducts, blood vessels, and tumors. This technology is of great significance in clarifying anatomical variations of the liver vascular system, accurately calculating future liver reserve, and aiding in surgical planning. This study was performed to assess the clinical value of preoperative liver 3D visualization assessment in the surgical treatment of patients with China liver cancer (CNLC) stageⅡ-Ⅲa hepatocellular carcinoma (HCC).Methods The clinical data of patients with CNLC Ⅱ-Ⅲa HCC who underwent surgical treatment in the Department of Liver Surgery and Transplantation, Zhongshan Hospital, Fudan University, between 2015 and 2017, were retrospectively analyzed. Based on their preoperative evaluation method, patients were classified into the conventional radiological and 3D visualization evaluation groups. Kaplan-Meier analysis was used to compare the two groups' postoperative recurrence-free survival (RFS) and overall survival (OS). Univariate and multivariate Cox regression analyses were performed to determine relevant risk factors affecting the prognosis of patients.Results A total of 110 patients with CNLC Ⅱ-Ⅲa HCC undergoing surgical treatment were included in the study, with 74 patients in the conventional radiological evaluation group and 36 patients in the 3D visualization evaluation group. There were no statistically significant differences between the two groups regarding sex, age, hepatitis B surface antigen, α-fetoprotein, Child-Pugh classification, tumor diameter, tumor number, macrovascular invasion, CNLC stage, prophylactic interventional therapy, and adjuvant targeted therapy (all P>0.05). The 90-d mortality rates were 2.8% (1/36) in the 3D visualization evaluation group and 4.1% (3/74) in the conventional radiological evaluation group, with no statistically significant difference (P>0.05). Kaplan-Meier survival analysis demonstrated that both OS and RFS in the 3D visualization evaluation group were significantly superior to those in the conventional radiological evaluation group (P=0.024; P=0.014). Multivariate Cox regression analysis revealed that preoperative 3D visualization assessment was an independent protective factor for OS and RFS (P=0.015; P=0.010).Conclusion Preoperative 3D visualization assessment can significantly improve the prognosis of patients with intermediate and advanced HCC undergoing surgical treatment. It has good application value in the surgical treatment of intermediate and advanced HCC and is recommended to be further explored and promoted.