Objective: To compare the therapeutic effects between emergency hepatectomy and emergency transcatheter arterial embolization (TAE) plus second-stage hepatectomy in treatment of spontaneous ruptured hepatocellular carcinoma (HCC). Methods: By searching several domestic and international databases, the eligible literature of studies was screened according to inclusion and exclusion criteria. Meta-analysis was performed by using StataSE 12.0 software. Results: A total of 11 studies were included, involving 581 patients, of whom, 305 cases underwent emergency hepatectomy and 276 underwent emergency TAE plus second-stage hepatectomy. In patients undergoing emergency TAE plus second-stage hepatectomy compared with those undergoing emergency hepatectomy, the incidence of perioperative complications was significantly decreased (OR=0.39, 95% CI=0.21–0.72, P=0.003), the 30-d mortality rate was significantly reduced (OR=0.21, 95% CI=0.08–0.56, P=0.002), and the 1- and 3-year survival rates were significantly increased (OR=0.48, 95% CI=0.32–0.73, P=0.001; OR=0.59, 95% CI=0.37–0.95, P=0.031). Conclusion: For resectable spontaneous ruptured HCC, emergency TAE plus second-stage hepatectomy can significantly reduce perioperative complications and mortality rate and increase survival rate of the patients compared with emergency hepatectomy.