Background: For initially diagnosed very early-stage hepatocellular carcinoma (HCC, VEH, i.e. single Hepatocellular Carcinoma ≤2 cm), surveillance after surgical resection (SR) or radiofrequency ablation (RFA) remains largely unclear. We conducted this multicenter study to explore optimal surveillance strategies and evaluate the current surveillance strategies for initially diagnosed VEH after SR/RFA to support the clinical follow-up schedule. Methods: A total of 6,105 initially diagnosed VEH patients who received SR/RFA from global centers were included. After the measurement of the recurrence rate of each month, delayed detection times for tumor recurrence of various follow-up strategies were calculated. The candidate strategies were evaluated according to the delayed detection times and the tumor volume doubling time (TVDT), and a preferable surveillance strategy was recommended. Results: The cumulative 1-, 2-, 3-, 4-, and 5-year recurrence probabilities were 12.7%, 25.9%, 35.7%, 43.7%, and 49.3%, respectively. Based on the monthly recurrence rate, programing surveillance schedules were tailored, which were more effective than current surveillance strategies under the same visits. When patients were followed up every 6 months, the delayed recurrence detection after curative treatment was expected to be 2.35 to 2.57 months. Given that 93.3% of patients did not have >TVDT with a rapid growth subtype when recurrent nodules were detected, a surveillance strategy with a 6-month interval was recommended. Conclusions: Six months of interval surveillance was conservatively supported in patients with VEH after curative therapy.