Background and Aims Spontaneous liver cancer rupture and hemorrhage is a severe complication. For the treatment of spontaneous rupture and hemorrhage of liver cancer, the preferred approach is rapid hemostasis using a simple and effective method, followed by further treatment when the overall and local conditions allow, to save the patient's life and extend their survival. This study aims to investigate the clinical value of sequential hepatectomy and intraperitoneal hyperthermic chemotherapy (HIPEC) in spontaneous rupture and hemorrhage of liver cancer.Methods A retrospective analysis was conducted on clinical data of 102 patients with spontaneous rupture and hemorrhage of liver cancer admitted to the Hepatobiliary Surgery Department of Yuxi People's Hospital between May 1, 2013, and December 1, 2021. Among them, 48 patients underwent hepatectomy with sequential HIPEC (observation group), while 54 underwent simple hepatectomy (control group). Relevant clinical variables were compared between the two groups of patients.Results There were no statistically significant differences between the two groups in terms of general preoperative information, major surgical parameters, postoperative pathology, length of hospital stay, postoperative drainage tube retention time, the incidence of Clavien-Dindo grade 2 or above complications, perioperative mortality and reoperation rate after recurrences (all P>0.05). The observation group showed higher total hospitalization costs, a higher postoperative cumulative disease-free survival rate and overall survival rate than the control group (both P<0.05).The observation group had a significantly lower incidence of peritoneal seeding metastasis than the control group (all P<0.05).Conclusion Sequential hepatectomy and HIPEC can reduce the incidence of peritoneal seeding metastasis in liver patients with spontaneous rupture and hemorrhage, improve postoperative disease-free survival rate and overall survival rate, and serve as a safe and effective treatment modality with significant clinical value. However, it is associated with higher costs.