Abstract
OBJECTIVE: To evaluate the efficacy and safety of timely staged hepatectomy (SH) following transarterial embolization (TAE) versus emergency hepatectomy (EH) for spontaneous rupture of hepatocellular carcinoma (SR-HCC). METHODS: Between January 2018 and December 2023, 109 patients with SR-HCC were admitted to our center receive SH (34 cases) or EH (75 cases). Performing 1:1 optimal matching propensity score matching (PSM) analysis, resulting in 34 patients in SH group and 34 patients in EH group. We compared perioperative data, peritoneal metastasis rates, recurrence rates, complication rates, and long-term survival outcome between the two matched groups. RESULTS: After PSM, baseline characteristics were well balanced between the SH and EH groups (standardized mean difference [SMD] < 0.1). Compared with the matched EH group, the SH group had a shorter intraoperative hepatic vascular clamping time, significantly less perioperative blood loss and transfusion volume, and a lower in-hospital mortality rate (P < 0.05). No significant differences were observed between the two groups in postoperative complication rates and peritoneal metastasis rates (P > 0.05). The SH group exhibited a trend toward improved recurrence-free survival (RFS) (Log-rank χ2 = 3.2, P = 0.074), although this did not reach statistical significance. Similarly, overall survival (OS) was comparable between the groups (Log-rank χ2 = 1.78, P = 0.183). CONCLUSION: Compared with EH, SH demonstrates superior perioperative safety, characterized by less surgical trauma and lower in-hospital mortality, without increasing postoperative complications and the risk of peritoneal metastasis. Therefore, SH may be considered the preferred treatment for SR-HCC, especially in cases of hemodynamic instability or impaired hepatic functional reserve.