Background and Aims: Surgical resection is the preferred treatment for hepatocellular carcinoma (HCC) at present. However, the use of anatomic resection (AR) or non-anatomic resection (NAR) is still controversial. This study was conducted to evaluate the efficacy and safety of using AR and NAR in the treatment of patients with HCC by Meta-analysis, so as to obtain evidence-based information resources for clinical practice.  
Methods: The studies comparing the clinical efficacy of AR versus NAR for HCC were collected by a computer-based search in several national and international databases from their inception to September 2020. After literature screening, data extraction and bias risk evaluation by two reviewers independently, Meta-analysis was performed using RevMan 5.3 software.
Results: A total of 33 studies were finally included, comprising 1 randomized controlled trial (RCT) and 32 cohort studies, involving 6 132 patients, with 3 029 cases in AR group and 3 103 cases in NAR group. The results of Meta-analysis showed that in AR group compared with NAR group, the postoperative early recurrence rate (OR=0.67, 95% CI=0.49–0.92, P=0.01) and intrahepatic local recurrence rate (OR=0.35, 95% CI=0.20–0.59, P=0.000 1) were reduced, and the 1-, 2-, 3-, and 5-year disease-free survival rates (DFS) (OR=1.26, 95% CI=1.12–1.42, P=0.000 1; OR=1.31, 95% CI=1.17–1.46, P<0.000 01; OR=1.32, 95% CI=1.19–1.48, P<0.000 01; OR=1.40, 95% CI=1.23–1.58, P<0.000 01), as well as the 5-year overall survival rate (OS) (OR=1.16, 95% CI=1.03–1.31, P=0.02) were improved. However, there were no statistical difference in intrahepatic distant recurrence rate (OR=1.11, 95% CI=0.80–1.54, P=0.54), extrahepatic metastasis rate (OR=0.97, 95% CI=0.78–1.22, P=0.83), 1-, 2-, and 3-year OS (OR=1.01, 95% CI=0.85–1.22, P=0.88; OR=1.15, 95% CI=0.99–1.33, P=0.06; OR=1.13, 95% CI=1.00–1.28, P=0.06) as well as the incidence of postoperative complications (OR=0.98, 95% CI=0.81–1.17, P=0.79) between the two groups. The subgroup analysis showed that the 1-, 2-, 3-, and 5-year DFS (OR=1.36, 95% CI=1.07–1.73, P=0.01; OR=1.55, 95% CI=1.23–1.95, P=0.000 2; OR=1.78, 95% CI=1.38–2.30, P<0.000 01; OR=2.07, 95% CI=1.46–2.94, P<0.000 1) as well as the 2-, 3-, and 5-year OS (OR=1.54, 95% CI=1.07–2.21, P=0.02; OR=1.46, 95% CI=1.11–1.92, P=0.007; OR=1.52, 95% CI=1.13–2.03, P=0.005) for HCC combined with microvascular invasion (MVI) in AR group were higher than those in NAR group.
Conclusion: The current evidence indicates that AR may reduce the incidence of postoperative early recurrence and intrahepatic local recurrence, and improve the DFS and long-term OS compared with NAR. In particular, for patients combined with MVI, AR is significantly better than NAR in terms of short- and long-term efficacy, which should be recommended for clinical application. Limited by the quality and quantity of the included studies, the above conclusions need to be verified by more multicenter randomized controlled trials with large sample size.