A patient from Shandong, Wang, 41 years old, was found to have a right hepatic hemangioma with a diameter of 5.6 cm on ultrasound 7 years ago, with no obvious discomfort and no special treatment. Three years ago, the hepatic hemangioma had grown to 8.1 cm, and the patient began to experience right upper abdominal distension and discomfort. The doctor recommended right hepatic hemangioma resection, but the patient did not accept the surgical recommendation due to fear of surgery and its related complications, and continued to be observed. Six months ago, the maximum diameter of the hemangioma rose to 10.6 cm, and the abdominal pain symptoms were significantly worse than before. The patient refused the traditional surgical treatment recommended by several hospitals and opted for a minimally invasive treatment modality, radiofrequency ablation. This treatment does not require traditional open surgery, but simply involves puncturing a radiofrequency needle through the skin into the body of the hemangioma and causing coagulative necrosis of the hemangioma by releasing radiofrequency currents to generate a temperature of about 100°C. The ablation treatment time is 2.5 hours. Within 3 days after the operation, the patient had only mild fever and painful discomfort in the right quarter rib area, and was discharged from the hospital 5 days after the operation. One month after surgery, the enhanced CT showed a significant reduction in the size of the hemangioma and essentially complete ablation. At a 6-month postoperative review, the ablated hemangioma had shrunk to 5.2 cm, and the patient’s abdominal pain and distension disappeared. In recent years, like the above patient, more and more patients with hepatic hemangioma have been cured by radiofrequency ablation therapy, a minimally invasive treatment. As early as 2007, we started to apply radiofrequency ablation to treat large hepatic hemangiomas over 5 cm. Years of clinical experience have confirmed that radiofrequency ablation has the advantages of definite efficacy, high safety, low trauma and low recurrence rate, and can be the preferred treatment for large hepatic hemangiomas (especially those with diameters of 5-10 cm). The results of our study were published in the world-renowned American Journal of Surgery in July 2012, which marked the international advanced level of using radiofrequency ablation to treat large hepatic hemangiomas in China. In order to help patients with hepatic hemangioma to better accept the modern concept of hepatic hemangioma treatment, the relevant knowledge is introduced as follows: I. Disease Overview Hepatic hemangioma is the most common benign tumor of the liver. There are significantly more women than men. Most of them are solitary, and about 20% of them are multiple. With the popularity of ultrasonography, the diagnosis rate of hepatic hemangioma is getting higher and higher. Hepatic hemangiomas have become one of the most common reasons for visits to hepatobiliary surgery clinics. Hepatic hemangiomas are mainly formed by the proliferation of vascular components in the liver, containing a large number of blood sinuses with a slow flow of blood through them. Most hepatic hemangiomas grow slowly, even without significant growth for several years; however, some hemangiomas are relatively fast and can grow exponentially in size within a few years. When the hepatic hemangioma is small, it has no obvious symptoms and has no effect on liver function. As the size of hemangioma gradually increases, the tumor may compress the surrounding tissues or cause infarction within the tumor, resulting in symptoms such as distension and pain in the upper abdomen. The larger the tumor and the more numerous it is, the more likely it is to produce symptoms. Only when there are multiple tumors in the left and right liver and the size of the tumor is huge, will it cause significant damage to liver function. Hepatic hemangioma has no tendency to become malignant, but there is a possibility of spontaneous rupture and bleeding as the tumor increases in size. Most hepatic hemangiomas are less than 5 cm in diameter and grow slowly, no special treatment is needed and regular observation is sufficient. 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 stomach distension, active treatment is needed. 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, a hepatic hemangioma that grew from 3 cm to 6 cm in the last 3 years, with a 7-fold increase in volume, is appropriate to be treated aggressively so as not to grow larger and larger and delay the best time for treatment. In another hepatic hemangioma, although it was already 6 cm when it was found, there was no obvious growth trend in the past 3 years. Although the lesion was large, it should not be actively treated if there were no obvious symptoms, and regular observation was sufficient. Treatment In the past, surgical resection was almost the only treatment for giant hepatic hemangioma, but this treatment method is very traumatic 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 hepatic hemangioma over 10 cm is not uncommon. 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 stage results and gained a more consistent understanding. Although radiotherapy and hepatic artery interventional hepatic hemangioma embolization can shrink the tumor and relieve the symptoms; however, 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, and has initially shown the advantages of definite efficacy, high safety, low trauma, and low recurrence rate. Our clinical experience in this field suggests that radiofrequency ablation can be the treatment of choice for large hepatic hemangiomas (especially those 5-10 cm in diameter); the results of this study were recognized by international colleagues and published in the world-renowned American Journal of Surgery. Radiofrequency ablation treatment of hemangiomas has several advantages: first, it is less invasive and can avoid surgery. 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; second, it facilitates the control of reasonable treatment timing. Due to the unparalleled minimally invasive nature of the treatment, the timing of treatment is no longer delayed as in the case of surgical treatment, and both patients and doctors are happy to accept a more positive and preventive treatment timing; third, to improve medical efficiency. The treatment also has the advantages of short hospitalization time and low cost. The most common complications of radiofrequency ablation for hepatic hemangiomas are pain, fever and hemoglobinuria, which usually disappear within 3 days after the procedure with no sequelae. It is more likely to occur when the tumor is large and the ablation time is long. The vast majority of hepatic hemangiomas only need regular observation and do not need 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 hepatic hemangioma treatment.