Because most emergent surgical operations for patients with spontaneous ruptured hepatocellular carcinoma (HCC) achieved hemostasis only, a conservative approach was chosen for management of initial bleeding in our institute. Elective surgery was performed in selected patients to attempt resection of the HCC after stabilization of the hemorrhage. From 1971, 68 of 87 patients with ruptured HCC received the conservative treatment, and 19 were treated by emergent surgery during the same period. Overall, one week and one month mortality rates were 26.5 per cent, 48.5 per cent in the conservative group, and 31.6 per cent, 47.4 per cent in the emergent operative group, respectively. Two patients in the emergent operative group underwent partial hepatectomy for a resectability of 10.5 per cent. Fifteen patients in the conservative group received elective laparotomy 1-3 weeks after control of the initial bleeding. Six underwent partial hepatectomy with a resectability of 40.0 per cent. In conclusion, conservative management is an effective approach for control of intraperitoneal hemorrhage in patients with ruptured HCC. Elective surgery on selected patients after hemostasis will increase the cancer resection rate in patients who undergo laparotomy and will give a better life expectancy than emergent laparotomy in patients with ruptured HCC.