Complex hepatic hemangioma is a challenging procedure in hepatic surgery, often associated with high surgical risks and great technical difficulties due to its massive size and its adjacency to or encasement of important vascular and biliary structures in the hepatic hilar region. How to achieve safe resection under the premise of effectively controlling intraoperative bleeding and maximally preserving liver function is a core issue in clinical practice. For complex hepatic hemangiomas, surgical indications must be strictly grasped, adhering to the principle of “no treatment for asymptomatic cases; observation for non-enlarging tumors”. Treatment decisions should be based on clear clinical symptoms and exclude the influence of adjacent organ diseases. Meanwhile, refined evaluation by a multidisciplinary team (MDT) is emphasized. In particular, preoperative three-dimensional computed tomography (3D-CT) reconstruction and magnetic resonance cholangiopancreatography (MRCP) should be utilized to clarify the spatial relationship between the tumor and the hilar structures as well as the venous system, and to calculate the residual liver volume, thereby formulating individualized surgical plans. Hepatic inflow occlusion techniques (such as the Pringle maneuver) can effectively reduce intraoperative bleeding and shrink the tumor, thereby increasing the operating space. Hilar plate-related techniques are helpful in protecting biliary structures during the detachment and lowering of the hilar plate. In addition, anatomical dissection following the concept of Laennec’s capsule and the application of liver hanging maneuver when necessary, can simplify the operation and reduce the risk of venous injury. Regarding the selection of surgical procedures, the individualized principle of “enucleation as the first choice, resection when necessary” should be followed, and flexibly applied according to the anatomical characteristics of the tumor. In terms of perioperative management, the application of low central venous pressure (LCVP) technique and autologous blood transfusion is crucial for reducing wound bleeding and the risk of allogeneic blood transfusion. Postoperatively, close monitoring of hemodynamic stability, liver function, and coagulation function is required, along with active prevention and intervention of complications such as bleeding, biliary leakage, and infection. Refined preoperative evaluation, clear surgical strategies, combined with a profound understanding of liver anatomy and related membranous structure techniques, are the keys to achieving safe resection of complex hepatic hemangiomas and reducing complications.