Background: Hepatic hemangiomas are predominantly benign, however symptomatic, macroscopic, or progressive lesions require active intervention. Transcatheter arterial chemoembolization (TACE) using pingyangmycin-lipiodol (PYM-Lipiodol) and liver surgery (LS) are widely adopted, yet comparative evidence on their efficacy and safety remains limited.

Methods: This retrospective study examined Chinese patients who received treatment for hepatic hemangioma at the Second Affiliated Hospital of Soochow University between January 2018 and February 2025. Eighty-one patients were divided into two groups (TACE, n = 42 or LS, n = 39). Postoperative target lesion shrinkage rate, complication rates, costs and quality of life were compared between the two groups. Further subgroup analysis was performed to investigate differences in effectiveness and complications.

Results: Six months after surgery, the hemangioma shrinkage rate was lower in the TACE group than in the LS group (79.41 ± 16.03% vs. 99.19 ± 4.01%, β = 19.31, 95% CI: 14.07 - 24.55, P < 0.001). However, remission rates were comparable (97.62% vs. 100.00%, RR = 0.997, P = 0.494). The TACE group experienced a lower overall complication rate, shorter hospital stays and lower total costs. Notably, the quality of life in the TACE group was significantly improved at 3 days postoperatively (97.74 ± 4.71 vs. 66.54 ± 11.31), with all relevant P-values < 0.001. However, the reintervention rate in the TACE group was 21.43%.

Conclusion: LS is superior in achieving immediate shrinkage in hepatic hemangiomas. TACE effectively reduces lesion size while minimizing the risk of complications and resource consumption, which is particularly beneficial for patients with multiple hepatic hemangiomas measuring 5–10 cm who are seeking less invasive procedures and faster recovery.