Objective: To investigate the clinical efficacy of emergency hepatectomy in treatment of spontaneous rupture and hemorrhage of hepatocellular carcinoma (HCC). Methods: The clinical data of 57 patients with rupture and hemorrhage of HCC undergoing emergency hepatectomy from January 2005 to December 2014 were retrospectively analyzed. Results: All patients underwent successful emergency hepatectomy, and the in-hospital mortality was 10.5%. The 1-, 3- and 5-year overall survival rate was 77.6%, 51.0% and 32.7% and disease-free survival rate was 69.4%, 40.8% and 18.4%, respectively, with the median survival time of 38.7 months. Of the 49 patients receiving follow-up, recurrence occurred in 38 cases, including intrahepatic recurrence in 18 cases (47.4%), and extrahepatic metastasis in 20 cases (52.6%). The multivariate analysis showed that tumor size larger than 10 cm (HR=2.43, P=0.031) and multiple lesions (HR=0.46, P=0.028) were independent factors affecting the postoperative survival of the patients. Conclusion: After appropriate selection, emergency hepatectomy for resectable HCC with rupture and hemorrhage is a life-saving and long-term effective treatment.