Anatomical resection can significantly reduce early recurrence rates in select hepatocellular carcinoma patients.

• In patients with tumors ≤5 cm and non-smooth margins, anatomical resection led to a 16.76% absolute reduction in early recurrence risk.
• Patients with these characteristics showed improved recurrence-free survival compared to non-anatomical resection.

Identifying patients with specific radiological features can optimize surgical decision-making and enhance outcomes in HCC treatment.

• Over 30% of patients who underwent non-anatomical resection might have benefited from anatomical resection.