Traditional surgery “can’t bear to do it when it’s small, and won’t do it when it’s big” With the popularity of ultrasound examination, the diagnosis rate of hepatic hemangioma is getting higher and higher. Most hepatic hemangiomas grow slowly, even without significant growth for several years; however, some hemangiomas grow relatively quickly and can grow exponentially in size within a few years. Hepatic hemangiomas do not have a tendency to become malignant, but as they increase in size, they can cause compression of surrounding tissues or infarction within the tumor, resulting in symptoms such as distension and pain in the upper abdomen, in addition to the possibility of spontaneous rupture and bleeding. In the past, surgical resection was almost the only treatment for giant hepatic hemangioma, but it is highly invasive and has many complications. According to the literature, the complication rate of surgical treatment of hepatic hemangioma is 27% and the morbidity and mortality rate is 3%. For a benign disease, surgical treatment has such a high complication rate and morbidity and mortality rate that it is difficult for both physicians and patients to easily accept. For hepatic hemangioma, due to the greater psychological pressure, the psychology of doctors is usually “can’t bear to do it if it’s small, but don’t want to do it if it’s big”, forming a strange circle that the tumor grows bigger and bigger, and the bigger it is, the more afraid to do it. This is also an important reason why liver hemangioma over 10 cm is not uncommon. Radiofrequency ablation can be preferred for large hepatic hemangioma. In the past decade, physicians in surgery and interventional medicine have been trying to apply various minimally invasive techniques to treat hepatic hemangioma and have achieved milestones. Although radiotherapy and hepatic artery interventional hepatic hemangioma embolization can shrink the tumor and relieve symptoms, these two local treatment options may produce more serious complications, which are contrary to the concept of minimally invasive treatment and difficult to be widely accepted. Radiofrequency ablation is a common minimally invasive treatment modality for liver malignancies. The main principle is to generate enough heat through radiofrequency current to cause coagulative necrosis of tumor tissues. In recent years, radiofrequency ablation has been applied experimentally to the treatment of hepatic hemangioma, which initially showed the advantages of definite efficacy, high safety, low trauma and low recurrence rate. Our clinical experience suggests that radiofrequency ablation can be the treatment of choice for patients with large hepatic hemangiomas (especially 5-10 cm in diameter). The results of this study were published in the American Journal of Surgery. Timing of treatment Selection is based on growth trend Most hepatic hemangiomas less than 5 cm in diameter and growing slowly do not require special treatment and can be observed regularly. When the growth trend of hemangioma is obvious, or when the tumor increases to the point of producing clinical symptoms such as abdominal distension and gastric distention, then aggressive treatment is required. It is worth mentioning that for the timing of treatment of hepatic hemangioma, between the growth trend and large size, the former should be emphasized, i.e., a significant growth trend is the most important indication for active treatment of hepatic hemangioma. For example, there was a hepatic hemangioma that grew from 3 cm to 6 cm in the last 3 years, with a 7-fold increase in volume. Such a hepatic hemangioma should be treated aggressively so as not to delay the best time for treatment. Although another hepatic hemangioma was already 6 cm when it was found, no significant growth trend was observed in the past 3 years. Although the lesion was large, it should not be treated actively if there are no obvious symptoms, and regular observation is sufficient. Most hepatic hemangiomas can be curatively treated by radiofrequency ablation through skin puncture; when the hemangioma is more closely related to the gastrointestinal, gallbladder and heart locations, laparoscopic radiofrequency ablation can also be used to reduce the incidence of organ damage and other complications. Because of the minimally invasive nature of this treatment modality, the timing of treatment is no longer postponed as much as surgery, and both patients and physicians are happy to accept a more aggressive and preventive timing of treatment. Most hepatic hemangiomas need only regular observation and do not require active treatment; if the growth trend of hepatic hemangioma is obvious and the tumor is enlarged to a certain degree, active treatment is appropriate; the treatment principle of hepatic hemangioma is changing from traditional surgery to minimally invasive treatment represented by radiofrequency ablation; radiofrequency ablation can be the first choice of treatment for hepatic hemangioma.