Hepatic hemangioma is the most common benign tumor of the liver, and its incidence accounts for about 5%-20% of liver tumors, with a prevalence of 40-50 years old and a male to female incidence of about 1:5-6. Most hemangiomas are less than 5 cm in diameter, and there is no definition of what diameter hemangioma can be called “giant” hemangioma. In China, hemangiomas with a diameter greater than 10 cm are often called “giant” hemangiomas, which account for about 3% to 5% of hemangiomas. Hemangiomas can be single or multiple, and multiple hemangiomas account for about 20% to 50%. Most hemangiomas do not have clinical symptoms and are discovered incidentally during physical examinations or abdominal imaging examinations for other diseases. Symptomatic hemangiomas are usually large in size, and right upper abdominal pain or epigastric fullness is the most common clinical symptom. Other rare clinical signs and symptoms include consumptive coagulopathy (Kasabach-Merritt syndrome), jaundice due to massive tumor compression of the bile ducts, indigestion-like symptoms due to compression of the stomach and duodenum, cardiac failure due to massive arteriovenous fistula formation, and hemorrhagic peritonitis due to spontaneous rupture of the tumor. Most hemangiomas can be diagnosed by conventional ultrasound. Needle biopsy should be used judiciously because of the risk of bleeding. There are several issues of importance in the treatment of hepatic hemangiomas. First, it is important to identify which hepatic hemangiomas require treatment. In general, regardless of the size of the tumor, as long as there are no clinical symptoms they can be followed up regularly without any treatment. The chance of spontaneous rupture is low even in large hemangiomas, so it is not advisable to use the avoidance of life-threatening spontaneous rupture of hemangiomas as a reason for surgery for asymptomatic hemangiomas. As of 2010, 46 cases of spontaneous hemangioma rupture have been reported in the global literature, and the average diameter of these spontaneously ruptured hemangiomas was 11.2 cm. Therefore, for those hemangiomas less than 10 cm in diameter, the probability of spontaneous rupture is small. In addition, it is important to judge the clinical symptoms associated with hemangiomas. The literature shows that only 12.6% of patients have clinical symptoms caused by the hemangioma itself, while many symptoms are associated with gastrointestinal or biliary tract diseases. Second, the risks and benefits of surgery should be objectively evaluated. Based on the fact that hemangioma is a benign disease that is not malignant, has a very low probability of spontaneous rupture, and rarely endangers the patient’s life, surgeons should select surgical cases judiciously. In particular, those cases where the tumor is huge, adjacent to the first or second hepatic hilar, and where the patient’s poor systemic condition makes surgery intolerable, regular follow-up or other non-surgical treatments should be used whenever possible. Thirdly, appropriate treatment methods should be selected. The treatment of hemangioma includes two categories: non-surgical treatment and surgical treatment. Non-surgical treatments include interferon and pinyamycin injections, radiation therapy and transhepatic artery embolization. TAE has been proven to be the most effective non-surgical treatment for hemangioma, which can reduce the symptoms on the one hand and reduce the size of hemangioma on the other; for some huge hemangiomas, TAE followed by surgical resection can reduce intraoperative bleeding and improve the safety of surgery. The limitations of TAE alone for hemangioma treatment are that in some cases, new collateral circulation is established after embolization, and tumor shrinkage is not obvious; in other patients, local ischemic infarction of the liver and liver abscess formation occur after embolization. Surgical treatment of hepatic hemangioma includes resection, removal, bundling and and liver transplantation. Surgical resection is the most commonly used method, but the use of anatomic or non-anatomic resection is controversial. Since hemangiomas often have no envelope and are not clearly defined from normal liver tissue, non-anatomic resection may leave some of the tumor tissue. We have seen a case of bleeding after surgery for a giant hemangioma, and reoperative exploration revealed some residual tumor tissue at the bleeding site. Therefore, it is safer and more thorough to perform anatomical hepatectomy while preserving as much normal liver tissue as possible. For huge hepatic hemangioma, combining TAE with surgery is a way to improve the safety of surgery, but there is no definite conclusion on how long to operate after TAE. The author’s experience is that the interval should not be too long, because on the one hand, it is easy to form new collateral vessels, resulting in poor embolization effect; on the other hand, after too long embolization time, due to local inflammatory reaction, the tumor often has adhesions with the diaphragm surface, and the intraoperative separation of these adhesions often leads to extensive blood leakage from the surgical wound, which increases the risk and difficulty of surgery. Liver transplantation is an effective treatment when giant hepatic hemangiomas invade the whole liver or when important structures in the hilar region are extensively involved, especially in patients with concomitant Kasabach-Merritt syndrome.