Hepatic hemangioma is a benign congenital disease of the liver that can grow in any part of the liver. To operate or not to operate for hepatic hemangioma and when to operate? The long-standing debate is one of the most testing for doctors and patients. For a patient with hepatic hemangioma, a wise surgeon must answer the following questions very clearly: Is the hepatic hemangioma diagnosed? Can it be operated? Do I need surgery? When should surgery be performed? Is the diagnosis of hepatic hemangioma confirmed? The vast majority of patients with hepatic hemangioma can be diagnosed through ultrasound, CT, MR, etc., but there are still a small number of patients who are difficult to distinguish from hepatocellular carcinoma. If hepatic hemangioma cannot be distinguished from liver cancer, the need for surgical preparation for liver cancer is greatly increased. Can hepatic hemangioma be operated? Whether a hepatic hemangioma can be removed is determined from a purely surgical point of view, i.e., from a safety or non-safety perspective. Of course, the success of surgical resection is very much related to the technical level of the surgeon. In other words, the surgical level of the surgeon for liver resection varies greatly. Both the surgeon and the patient must evaluate the level of the surgeon. Do I need surgery for hepatic hemangioma? Hepatic hemangiomas are benign tumors that rarely become cancerous. However, due to their slow-growing biology, tumor cells continue to grow at a rate of 1-2mm per year, and after ten years they will erode normal liver tissue and cells, severely affecting the functional reserve of the liver, although few actually rupture and bleed, and there is no significant relationship between rupture and bleeding and size. Therefore, the need for surgery for hepatic hemangioma has long been highly controversial in the industry. Because, after all, hepatic hemangiomas are benign tumors, the risk of surgery is an issue that must be considered. The authors’ opinion is that instead of waiting for a very large hepatic hemangioma before surgery, it is better to take advantage of the fact that hepatic hemangiomas are relatively small and have a greater surgical safety margin. In particular, a relatively small hemangioma (2-5 cm) is when it is located in the bare area of the liver, or next to the inferior vena cava, when there are obvious symptoms, and when the patient strongly requests it. If the hemangioma is relatively small, located at the edge of the liver, and if it is combined with other diseases requiring surgery, such as stomach, bile, or small intestine, it should also be aggressively removed surgically. As we can see, the decision of whether to operate for hepatic hemangioma depends on the risk of surgery, the level of the surgeon, the patient’s symptoms and the patient’s knowledge of the disease, and must be considered together and with the patient’s full understanding and support. Therefore, it will be a great test for both the patient and the surgeon.