Background and Aims The application of medical imaging three-dimensional reconstruction provides more intuitive and accurate data support for preoperative evaluation, surgical approach planning and surgical operation. However, there is limited support from high quality evidence for whether the three-dimensional reconstruction technique is more beneficial for liver resection. Therefore, this study was conducted to systematically evaluate the clinical effects of three-dimensional reconstruction and two-dimensional imaging in the assistance of hepatectomy.Methods The publicly published clinical studies comparing three-dimensional reconstruction and two-dimensional imaging for the assistance of hepatectomy were collected by searching several national and international online databases. Retrieval time was from the inception of the databases to December 2018. After data extraction and bias risk evaluation of the included studies, Meta-analysis was performed using RevMan5.3 software.Results A total of 12 clinical studies were included, involving 1 428 patients with 705 cases in two-dimensional group and 723 in three-dimensional group. Results of Meta-analysis showed that in three-dimensional group compared with two-dimensional group, the incidence of postoperative complications was decreased (OR=0.69, 95% CI=0.51-0.92, P=0.01), the intraoperative blood loss was reduced (MD=-63.85, 95% CI=-98.66-29.04, P=0.000 3), the incidence of postoperative liver failure was declined (OR=2.19, 95% CI=0.96-5.00, P=0.06), the postoperative recurrence rate was decreased (OR=0.29, 95% CI=0.16-0.53, P<0.000 1), and the postoperative survival rate was improved (OR=2.43, 95% CI=1.61-3.68, P<0.000 1).Conclusion The current data show that the use of three-dimensional reconstruction technology to assist liver resection can reduce the amount of intraoperative blood loss, reduce postoperative complications and recurrence rate, as well as improve postoperative survival rate. Therefore, the three-dimensional reconstruction technique is worthy of application and popularization in the assistance of hepatectomy.