Hepatic hemangiopericytoma is a relatively common benign tumor of the liver. In the past 20 years, due to the wide application of diagnostic imaging techniques such as ultrasound, CT and MRI, the detection of hepatic hemangiomas has increased significantly, and many asymptomatic hepatic hemangiomas have been found clinically. Faced with such a large number of patients, how to choose the treatment modality is the main problem faced by surgeons. In the past, the size of the hemangioma and the potential risk of rupture and bleeding were often used as the main basis for surgical treatment, resulting in rules such as “surgical treatment is required for tumors larger than x x cm”. For example, in 1970, Adam referred to a hepatic hemangioma >4 cm in diameter as a giant hemangioma and used this as an indication for surgery. With the increasing understanding of hepatic hemangioma, many scholars have disagreed with such a criterion for surgery, such as Adson, who proposed that hepatic hemangioma larger than 10 cm in diameter should be operated. Many domestic experts have also put forward different views on the 4 cm specified by Adam based on their own experience, and proposed that surgery can be performed only if the tumor diameter is >15 cm, >10 cm, >8 cm or >5 cm (with or without clear clinical symptoms). The source of this disparity in results may be due to different personal opinions, different surgical centers, different cases, etc. New data suggest that tumor size and concern about ruptured bleeding are not criteria for the need for surgical treatment of hepatic hemangiomas. Terkivatan et al [1 observed 38 cases of hepatic hemangioma (mean diameter 6 cm) over 52 months of follow-up and found that 12 cases had mild abdominal discomfort, which was not related to the size of the hemangioma, and that in subsequent observations, the patients’ symptoms disappeared or decreased without complications such as tumor enlargement or rupture and bleeding. Farges 1995 reported only 1 ruptured hemorrhage in 163 patients, Wang Xuehao in China reported only 1 ruptured hemorrhage in 164 cases, and Chen Han In China, Wang Xuehao reported only 1 ruptured bleeding out of 164 cases, and Chen Han reported no ruptured bleeding out of 980 patients. We also have similar clinical findings. Therefore, we believe that the previous view of surgical treatment based on tumor size lacks scientific basis. For asymptomatic hepatic hemangioma, even if the lesion is large, there is no need to rush to surgery, but can be temporarily observed; on the contrary, for patients with persistent symptoms, surgical treatment should be performed regardless of the size of the lesion. We believe that the indications for surgery for hepatic hemangioma are: (1) the patient has obvious and persistent clinical symptoms due to hepatic hemangioma; (2) the patient has clinical complications secondary to hepatic hemangioma, such as hepatic hemangioma rupture and bleeding, severe thrombocytopenia, anemia, etc. The traditional surgery for hepatic hemangioma is mainly hepatectomy. Irregular resection of the tumor-bearing liver can be performed for hemangiomas in the peripheral part of the liver, and tumor stripping resection is appropriate for hemangiomas in the central area of the adjacent important access hepatic vessels. However, it should be noted that the treatment of hepatic hemangioma by hepatic artery embolization should emphasize the importance of selective interventional techniques, which have been reported to lead to severe liver failure and fatal biliary complications. Therefore, we believe that the treatment of hepatic hemangioma should follow the following principles: (1) the size of hepatic hemangioma is not a criterion for its treatment; (2) whether hepatic hemangioma requires treatment depends on the presence or absence of clinical symptoms and the severity of symptoms; (3) treatment should also be provided when the patient’s study, work and life are seriously affected by the psychological stress caused by the presence of the disease.