Background The optimal surgical strategy to lessen the risk of hepatocarcinoma (HCC) recurrence is debated. This study aimed to investigate the role of anatomic resection (AR) and parenchyma-sparing resection (PSR) in HCC recurrence patterns. Methods The study analyzed 384 cirrhotic patients with a first diagnosis of HCC. Of these patients, 142 underwent AR, and 242 underwent PSR. The two groups were unbalanced at the univariate analysis. To minimize this bias, a 1:1 propensity score-matching analysis (PSA) was used. Disease-free survival (DFS) curves were analyzed by the Kaplan-Maier method. Results The PSA allowed pairing of 200 patients (100 for AR and 100 for PSR). In this study, 59 patients (62.8%) had recurrence after AR compared with 58 patients (63.7%) after PSR ( p  = 0.891). The rates of local recurrence were respectively 15.3% and 15.5% ( p  = 0.968). When microvascular invasion was considered, the median DFS was 10.7 months for AR and 9.4 months for PSR ( p  = 0.607). In comparisons of AR and PSR, DFS did not differ significantly between subgroups with high histologic grading ( p  = 0.520), multiple nodules ( p  = 0.307), and Child–Pugh B ( p  = 0.679). Conclusion Excision of the anatomic segment did not seem to reduce the rate of relapse or recurrence patterns significantly, even in high-risk subgroups.