Is transarterial embolization plus two-stage hepatectomy the optimal strategy for the treatment of spontaneous rupture of hepatocellular carcinoma?

We were intrigued to read the retrospective study by Wang et al.“Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma”(1)published in the latest issue of Hepatobiliary Surgery Nutrition.The authors elaborated the extremely significant conclusion that transarterial embolization(TAE)plus two-stage hepatectomy might be the optimal treatment for spontaneous rupture of hepatocellular carcinoma(RHCC)patients,whose overall survival(OS)and disease-free survival(DFS)aren’t significantly different compared with non-ruptured hepatocellular carcinoma(NHCC)patients undergoing hepatectomy,and had a better prognosis than other treatment,including TAE alone and one-stage hepatectomy.We highly appreciate the author’s research results.However,when we read the document,there were some shortcomings.