e16259 Background: While surgical resection stands as the primary curative approach for early-stage hepatocellular carcinoma (HCC), the looming risk of recurrence significantly impacts long-term outcomes. This study investigates the influence of regular recurrence surveillance on the long-term prognosis of HCC patients after curative surgical resection. Methods: In this large multicenter observational study, patients who underwent curative resection for early-stage (BCLC stage 0/A) HCC were divided into two cohorts: those adhering to a structured surveillance protocol (regular check-ups every 2-3 months for the first two years, followed by biannual check-ups) and those with irregular or no recurrence surveillance. Key metrics compared between these groups included overall survival (OS), time-to-recurrence (TTR), and post-recurrence survival (PRS). Results: The study encompassed 1,544 patients, with 786 (50.9%) adhering to regular surveillance for postoperative recurrence. Patients under regular surveillance, as opposed to those with irregular/no surveillance, demonstrated a comparable TTR (median: 61.4 vs. 66.2 months, P = 0.161). However, they exhibited significantly improved OS (median: 113.4 vs. 94.5 months, P = 0.010) and PRS (median: 37.9 vs. 16.3 months, P < 0.001) in cases of recurrence. Multivariable Cox-regression analysis identified regular recurrence surveillance as an independent protective factor, significantly enhancing OS (HR: 0.777; 95% CI: 0.663-0.910; P = 0.002) and PRS (HR: 0.523; 95% CI: 0.428-0.638; P < 0.001). Conclusions: Regular recurrence surveillance markedly improves OS and PRS in patients undergoing surgical resection for early-stage HCC. This study underscores the critical importance of adherence to a structured surveillance regimen in HCC management, potentially enhancing opportunities for subsequent curative interventions and improving long-term survival outcomes. [Table: see text]