Most of previous researches on anatomic resection (AR) in early hepatocellular carcinoma (HCC) were conducted in high-volume centres with controversial results. This study aims to provide evidence of the utilization of AR in early HCC at population level.The Surveillance, Epidemiology, and End Results 18 registries database (2004-2015) of the USA was utilized to identify early HCC cases ≤5 cm. Overall survival and cancer-specific survival were both analysed.A total of 976 AR and 409 wedge resection (WR) cases were identified. For the post-operative (death within 1 month) and middle-term (death within 3 years) survival, effect of AR was found to be similar to that of WR after adjusting other covariates. However, for the long-term (death within 5 years) survival, the therapeutic effect of AR proved to be superior to that of WR (relative risk (RR) 0.655 for overall survival; RR 0.658 for cancer-specific survival, both P < 0.05). Furthermore, subgroup analyses suggested that patients characterizing as male, tumour size 1-30 mm, vascular invasion and normal alpha-fetoprotein were more likely to benefit from AR in long-term prognosis (all P < 0.05).This study suggests that AR, when adopted at population level, is a better choice in comparison with WR in early HCC based on the evidences that it could provide equivalent post-operative, middle-term prognosis and superior long-term survival.