Abstract: Background　Giant hepatic hemangioma (GHH) is traditionally managed by surgical resection as the primary treatment modality. In recent years, transarterial embolization (TAE) combined with laparoscopic microwave ablation (LMWA) has been increasingly applied in the treatment of GHH. However, limited attention has been paid to the impact of lesion anatomical location on the safety and efficacy of ablation. Objective　To evaluate the differences in perioperative outcomes among patients with GHH at different anatomical locations undergoing sequential TAE + LMWA. Methods　A retrospective analysis was conducted in patients with GHH who underwent TAE + LMWA at the Department of Hepato-Pancreato-Biliary Surgery of PLA General Hospital from November 2021 to August 2024. According to lesion location, patients were categorized into the liver subcapsular (LS) group and the liver parenchymal (LP) group. All patients were followed up for 12 months postoperatively. Treatment efficacy was evaluated based on imaging findings and classified as complete cure, clinical cure, or incomplete cure, and the effective cure rate was calculated accordingly. Perioperative outcomes and postoperative complications were also compared between the two groups. Results　A total of 76 patients were included, with 59 cases in the LS group and 17 cases in the LP group. In the LS group, the mean age was (48.4±9.3) years, with 17 males (28.8%) and 42 females (71.1%), and the median maximum tumor diameter was 11.72 (10.52 - 12.28) cm. In the LP group, the mean age was (47.1±7.5) years, with 7 males (41.1%) and 10 females (58.8%), and the median maximum tumor diameter was 10.50 (10.10 - 11.30) cm. No significant differences were observed between the two groups in baseline characteristics, including sex, age, and tumor size (all P>0.05). The maximum tumor diameter was significantly reduced in both groups compared with preoperative values, with no significant difference between the two groups (6.30±2.02 cm vs 5.45±1.26 cm, P>0.05). Cure rates were comparable between the two groups (P=0.224). There were no significant differences in perioperative outcomes, including intraoperative blood loss, operative time, postoperative hospital stay, hospitalization cost, and recovery of gastrointestinal function (all P>0.05). Regarding postoperative complications, the incidence of fever was numerically higher in the LP group than that in the LS group (47.0% vs 27.1%, P=0.119), while the overall complication rates were not significantly different between the two groups (P>0.05). Conclusion　Under standardized sequential TAE + LMWA combined with decompression channel technique, lesion anatomical location has a limited impact on postoperative recovery and complication rates in patients with GHH. This strategy demonstrates favorable safety and efficacy.