Hepatic hemangioma (HCH) is the most common benign tumor of the liver, with an incidence of 5 % to 7 %. With the development of routine physical examinations and medical imaging in recent years, the detection rate of hepatic hemangioma incidence has increased year by year. The development of treatment strategies for hepatic hemangioma requires an in-depth understanding of the history and future direction of clinical treatment research. Searching the SCI (Web of Knowlege) database, as of 2012-6-20, 3099 papers were included in the search topic hepatic hemangioma (liver hemangioma), and clinical reports of hepatic hemangioma treatment case reports (669 papers) accounted for 21.6%, with retrospective case studies predominating among the 2210 papers. Large-scale, multicenter, randomized controlled (RCT) studies are still lacking due to the limitations of incidence, the variety of treatment modalities, scientific research methods and medical ethics considerations. Recently, based on the accumulation of cases, research literature on evidence-based medicine has begun to emerge. The trend regarding minimally invasive treatment, comprehensive treatment, and personalized diversified treatment is gradually becoming the mainstream of clinical research. The diversification of treatment means and the updating of treatment concepts have led to the continuous improvement and deepening of our understanding of hepatic hemangioma treatment in practice. However, there are still differences in understanding and debates on treatment indications, risk assessment, method selection, cost-benefit ratio and health economy. Zheng Yamin, Department of General Surgery, Xuanwu Hospital, Capital Medical University I Surgical indications and timing of treatment for hepatic hemangiomas Hepatic hemangiomas consist of many dilated blood sinuses of variable size, which are malformed manifestations of branches of the hepatic artery, with blood supply almost exclusively from the hepatic artery, independent of the portal vein, and in some patients accompanied by arteriovenous fistulas. It can be divided into cavernous hemangioma, sclerosing hemangioma, vascular endothelioma and capillary hemangioma, most of which are cavernous hemangioma. Patients are mostly female and can occur at any age. Most hepatic hemangiomas are <5cm in diameter, and if the tumor is >5cm in diameter, it is called a giant hemangioma. >Most hepatic hemangiomas are <5cm in diameter. Since there is no definite and effective drug treatment option for hemangioma, surgical treatment is the main treatment option. However, surgical treatment is an invasive treatment, so whether to choose surgical treatment for hepatic hemangioma, when to choose surgery, and what method to choose? To answer these questions, a comprehensive analysis of tumor size, clinical symptoms, tumor growth rate, whether it is accompanied by acute bleeding, patient anxiety and treatment cost is needed to achieve a comprehensive consideration of treatment benefits, surgical risks and psychosocial factors of hepatic hemangioma.1 Asymptomatic hemangioma For asymptomatic hemangioma, whether it should be surgically removed remains a major issue of debate. Some recommend greater than 5 cm, while others believe it should be controlled to 10 cm or more. Doctors and patients are filled with the desire to operate with the good intention of getting this lesion clean and tempted by the good results of laparoscopic resection. A word of caution is needed not to overlook the medically induced damage associated with the surgery itself, which is often difficult to see in the press. Rupture, especially spontaneous rupture, is the main risk during observation because of the perceived small chance of malignancy. What is the risk of hepatic hemangioma rupture?Donati, M [1] reviewed the medical literature in multiple languages (English-French-German-Italian-Spanish) over a 120-year period from 1898-2010 and found 97 reported cases of hepatic hemangioma rupture, including 46 (47.4%) spontaneous ruptures and predominantly in patients under 40 years of age. The size of tumor rupture ranged from 1-37 cm, with a median diameter of 11.2 cm. It can be seen that tumor rupture is a rare case, especially in the last 20 years the number of reports has further decreased, but the overall mortality rate is about 35% due to poor attention to the consequences, with a reported mortality rate of 78% [2], and attention should be paid to special sites, especially hepatic hemangiomas larger than 11 cm. Nowadays, we are gradually moving out of the mindset of deciding surgery solely based on the size of hemangioma, and patients with asymptomatic or mild abdominal symptoms do not need treatment but only regular review [3, 4]. The focus of observation is on tumors with huge size, rapid growth, close to the surface of the liver, especially in areas susceptible to trauma, which require active treatment once clinical symptoms appear.2 Clinical manifestations of hepatic hemangiomas are mainly characterized by the following clinical symptoms: abdominal pain, upper abdominal cramps, pressure discomfort, dyspepsia, and loss of appetite due to compression of the liver and surrounding organs by the enlarged tumor and intra-tumor thrombosis If intra-tumor bleeding or hemangioma rupture and abdominal bleeding occur, abdominal pain, fever, or even hemorrhagic peritonitis and hemorrhagic shock can be life-threatening. Some patients may develop Kasabach-Merrit syndrome [5] in which excessive depletion of blood cells is destroyed, manifested by decreased platelets, coagulation dysfunction, and hemorrhagic purpura. If there is an increase in the amount of blood returned to the heart, the heart burden increases leading to heart failure, mostly in neonates and children. The development of imaging examinations such as B ultrasound, CT and MRI has led to a significant increase in the rate of diagnosis, and dynamic follow-up can provide insight into tumor growth. Etemadi A [6] et al. conducted a long-term follow-up of 198 patients from 1997 to 2007 (mean 3.2 +/- 2.5 years), and 80% of the patients received 1-5 imaging reviews. The most predominant symptom found in patients was abdominal pain, which was closely related to gastrointestinal irritability and less related to tumor size, with single giant tumors often presenting with persistent pain. 35% of tumors showed progressive growth, mostly in single hemangiomas. It is generally accepted that the absolute indications for surgical resection of hepatic hemangioma are rupture and bleeding, rapid tumor growth, or Kasabach-Merrit syndrome, rather than the absolute size of the tumor. Patients with large and rapidly growing hepatic hemangiomas or those located in the subepithelium with a potential risk of spontaneous or traumatic rupture and bleeding are considered to have indications for surgical treatment.