Hepatic hemangioma is a common benign tumor, accounting for 73% of benign liver tumors; it is the second most common tumor of the liver after liver metastatic cancer; it is more common in middle-aged female patients, with a male to female ratio of 1:5-6 . Histologically, hepatic hemangiomas can be divided into cavernous hemangiomas, sclerosing hemangiomas, vascular endothelial cell tumors and capillary hemangiomas. According to the size of tumor diameter, hepatic hemangioma can be divided into three levels: small hemangioma (<5 cm), large hemangioma (5-10 cm) and giant hemangioma (≥10 cm). Some foreign scholars classify those with diameters >4 cm as large hemangiomas. Hepatic hemangiomas are slow-growing, have no tendency to become malignant, and spontaneous rupture is rare. If the tumor is small, it is often asymptomatic and can be followed up and observed; when the growth trend is obvious or the tumor is large enough to have clinical symptoms, active treatment is required [1-3]. In the past, surgical resection was almost the only treatment for hepatic hemangioma, but it was highly invasive and had many complications [3-8]. For benign diseases, highly invasive surgical treatment puts a lot of psychological pressure on both doctors and patients. This is also an important reason why clinical giant hepatic hemangioma is not rare. Over the years, clinicians have tried hard to use minimally invasive means to treat hepatic hemangiomas. Hepatic artery interventional embolization and radiation therapy have been used experimentally in the treatment of hemangiomas, but their efficacy is uncertain and may lead to serious complications . In recent years, radiofrequency ablation (RFA) therapy has been applied to the treatment of hepatic hemangiomas on a trial basis, showing the advantages of definite efficacy, minimal invasiveness, safety, good patient compliance, and good prospects for application. There is growing evidence that local treatment represented by RFA is expected to become the treatment of choice for hepatic hemangioma, which will lead to a significant change in the treatment paradigm of hepatic hemangioma. The timing of hepatic hemangioma treatment tends to be conservative in the traditional treatment paradigm Although most hepatic hemangiomas grow slowly or even have no significant tendency to grow, a few have a significant tendency to grow. in a long-term follow-up, Yeh et al. monitored 180 hepatic hemangiomas in 130 patients and found that 14 (7.7%) lesions in 13 patients increased in size and doubled in hemangioma volume in 17.3 to 178.1 months [ 2]. Schnelldorfer et al. clinically observed 91 patients with asymptomatic hepatic hemangiomas >4 cm and found that the mean time to increase the size of the tumor beyond 1 cm in 14% of patients was 5.1 ± 4.4 years after the first diagnosis. When hemangiomas grow to a certain size, they usually cause significant and persistent symptoms. Currently, there are no standardized indications for the treatment of hepatic hemangiomas. Surgical resection is the traditional treatment for hepatic hemangioma, but this treatment is highly invasive and has many complications. The literature reports that the complication rate of surgical treatment of hepatic hemangioma is 27% and the morbidity and mortality rate is 3%. Treating a benign tumor such as hepatic hemangioma by surgical resection with some risk can cause a lot of psychological stress to both physicians and patients. As a result, there is a clinical tendency to conservatively defer treatment of hepatic hemangiomas and rarely aggressively pursue prophylactic treatment. The result is usually that the hemangioma grows larger and more difficult to treat and the risks increase the longer we wait. Absolute indications for surgical treatment include ruptured and bleeding tumors, rapid growth of intra-tumor bleeding, complications of Kasabach-Merritt syndrome, compression of bile ducts or portal veins with symptoms, and difficulty in excluding other tumors with unknown diagnosis. However, cases of hepatic hemangioma with acute or severe complications are rare in clinical work; with the upgrade of imaging equipment and improvement of diagnostic level, the differential diagnosis of hepatic hemangioma is no longer a difficult problem for clinicians [5]. We often have to face patients with hepatic hemangioma who have tumors protruding from the liver envelope, large tumors (5-10 cm), slow-growing tumors, or mild symptoms such as right upper abdominal distension and discomfort. Opinions are divided on whether this group of patients should be treated surgically. Two large retrospective studies from the United States and Germany with long-term follow-up of two groups of patients with hepatic hemangiomas treated with surgical resection and clinical observation had similar methods and inclusion criteria but contradictory conclusions [3,4].Schnelldorfer et al [3] followed 289 patients with hepatic hemangiomas (>4 cm in diameter) diagnosed between 1985 and 2005, 56 of whom were surgically resected and 233 under observation; the results revealed a 14% incidence of postoperative complications in the surgical group and a 20% incidence of complications (persistent or new hemangioma-related symptoms) in the observation group, which was not statistically significant between the two groups (p=0.45). Therefore, they concluded that hepatic hemangiomas should be dynamically observed and surgical treatment should be limited to patients presenting with severe complications.Yedibela et al [4] followed 246 patients with hepatic hemangiomas diagnosed between 1988 and 2009, of whom 103 hepatic hemangiomas (4-23 cm) underwent surgical resection and 143 hepatic hemangiomas (1-21 cm) were observed; the results found The incidence of postoperative complications was 35% in the surgical group and up to 57% in the observation group (persistent or new hemangioma-related symptoms, death); although the incidence of complications was not statistically significant between the two groups (P=0.08), two patients in the observation group died of post-traumatic hepatic vascular rupture and bleeding after resuscitation. Therefore, they believed that large hepatic hemangiomas should be treated more aggressively. It can be the treatment of choice for hepatic hemangioma It is a minimally invasive treatment modality commonly used for liver malignancies and is one of the curative means for early hepatocellular carcinoma. the main principle is to generate enough heat by radiofrequency current to cause coagulative necrosis of the tissue. in 2003, Cui et al. first applied RFA to treat hepatic hemangioma, suggesting that RFA might be used as one of the treatment options for hepatic hemangioma. Since then, no major breakthroughs have been achieved in this field of research. There are three main reasons for this: first, there are limited cases of hepatic hemangioma that need to be treated clinically, and the literature related to RFA for hepatic hemangioma are all case reports and retrospective studies with small samples, and the level of literature is low; second, RFA for hepatic hemangioma is still in its infancy and experience is not accumulated enough. The cases in the literature are very carefully selected, mostly choosing large hemangiomas, and there are few reports on the treatment of giant hemangiomas. In 2007, Park et al [17] reported that ultrasound-guided percutaneous RFA was used to treat 25 >4 cm hemangiomas (including 10 <5 cm hemangiomas, 10 ≥5 cm and <10 cm hemangiomas, and 5 ≥10 cm hemangiomas) in 24 patients; the complete ablation rate was 92.0%, including 100% complete ablation of 20 large hemangiomas and 60% complete ablation of 5 giant hemangiomas. The complete ablation rate was 60% for 20 large hemangiomas and 60% for 5 giant hemangiomas, of which 2 giant hemangiomas failed the RFA treatment technique (fear of thermal damage to the surrounding organs during ablation). Therefore, they concluded that RFA is suitable for the treatment of large hemangiomas, but not for giant hemangiomas. Although the article was published in a high-level journal, the design was significantly biased: the authors' team, all of whom are imaging physicians, do not perform laparoscopic RFA, making it difficult to take full advantage of RFA treatment. Giant hepatic hemangiomas are bound to be closely related to the surrounding organs due to their large size; a laparoscopically established pneumoperitoneum can fully separate the tumor from the surrounding organs, thus allowing for maximum complete ablation under the premise of ensuring treatment safety. The authors summarized the cases of hepatic hemangioma treated by RFA before 2010, and the results showed that RFA can treat large hepatic hemangioma minimally invasively, safely and effectively; the treatment of giant hepatic hemangioma, although the treatment effect is satisfactory, has a high complication rate due to the lack of experience when the treatment was initially carried out. Based on this work, the authors significantly reduced the ablation-related complications of giant hepatic hemangioma by changing the treatment concept, improving the treatment strategy, and upgrading the ablation equipment. Their specific measures include: (i) suggesting the laparoscopic route as the preferred ablation route for giant hepatic hemangioma; (ii) focusing on the characteristics of giant hepatic hemangioma as a benign disease, it is not advisable to force complete ablation at once, and repeat RFA strategy can be chosen if necessary; (iii) proposing a series of ablation strategies, including ablation electrodes passing through normal liver tissue into hepatic hemangioma, appropriately extending the ablation time of the first ablation point, adopting The ablation strategy of "edge first, then center" and intermittent blocking of the first hepatic portal blood flow under the laparoscopic path were proposed; ④ The ablation electrode with cold circulation and straight needle design is more suitable for the ablation treatment of hepatic hemangioma because of its features of concentrated function release and no coking of the tissue around the needle. The above information shows that the treatment mode of hepatic hemangioma is changing from traditional surgical treatment to local ablative treatment mode represented by RFA, which can be the preferred mode of hepatic hemangioma treatment. Recently, microwave ablation therapy has also been successfully applied in the treatment of hepatic hemangioma, which further indicates that local thermal ablation is the trend in the treatment of hepatic hemangioma; however, more evidence-based medical evidence is needed to support which local ablation modality is more suitable for the treatment of hepatic hemangioma. The timing of hepatic hemangioma treatment should be more aggressive under the minimally invasive treatment paradigm With the advent of minimally invasive treatment for hepatic hemangioma, the treatment concept of hepatic hemangioma has been influenced to some extent, lowering the psychological "threshold" for aggressive treatment of hepatic hemangioma for both doctors and patients and making aggressive preventive treatment possible. The authors concluded that the timing of treatment for hepatic hemangioma should emphasize the former, between growth trend and large size, i.e., a significant growth trend is the most important indication for aggressive treatment of hepatic hemangioma. For example, there was a hepatic hemangioma that grew from 3 cm to 6 cm in the last 3 years, a 7-fold increase in size. Such a hepatic hemangioma should be treated aggressively to avoid growing larger and larger and delaying the best time for treatment. Another hepatic hemangioma was already 6 cm at the time of discovery, but no significant growth trend was observed in the past 3 years. Although the lesion was large, there was room for continued observation if there were no obvious symptoms. Based on the above theory and with reference to Park et al, the authors concluded that the timing of treatment for hepatic hemangioma should be based on the following two points: (1) a diameter of ≥5 cm and an increase of >1 cm in tumor diameter suggested by imaging during clinical follow-up observation within 2 years; (2) a diameter of ≥5 cm and the presence of persistent abdominal pain or discomfort associated with hemangioma. Gastroscopy and colonoscopy have been performed to exclude symptoms that may be caused by gastrointestinal diseases. In conclusion, the treatment mode of hepatic hemangioma is changing from the traditional surgical treatment to the local ablation treatment represented by RFA; RFA can be the preferred mode of hepatic hemangioma treatment. With the minimally invasive treatment mode of hepatic hemangioma, the timing of hepatic vascular treatment tends to be more aggressive; for hepatic hemangioma with obvious growth trend, aggressive treatment is appropriate.