Solitary hepatocellular carcinoma (HCC), defined as a single lesion without distant metastasis, is a subtype of primary liver cancer with high surgical resectability. Hepatectomy is considered the most effective curative treatment; however, the optimal surgical approach and resection margin width remain controversial. This review systematically examines the impact of anatomical resection (AR) versus non-anatomical resection (NAR) on prognosis in various clinical contexts. It highlights the advantages of AR in patients at high risk of recurrence, while also acknowledging the value of NAR in preserving liver function. Furthermore, the article discusses the role of wide versus narrow resection margins in postoperative recurrence control, indicating that wide margins may help eliminate potential micrometastases, though postoperative risks must be balanced in patients with limited hepatic reserve. The review proposes that a combined strategy involving both surgical approach and margin width may exert a synergistic effect in improving outcomes. Looking ahead, the integration of imaging techniques, preoperative predictive models, and individual biological characteristics will facilitate personalized and precise surgical planning, thereby optimizing the prognosis of patients with solitary HCC.