Purpose <p>This meta-analysis aims to evaluate thermal ablation for giant hepatic hemangiomas (GHHs) and compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA).</p> Methods <p>A systematic review and meta-analysis followed the Cochrane Collaboration Handbook and PRISMA 2020 guidelines. Eligible studies reporting on patients with GHHs (≥ 4&#xa0;cm) treated with MWA or RFA were identified through Medline, Scopus, and Web of Science databases. Primary outcomes included technical success (complete and accurate execution of the intended MWA or RFA procedure as per the study protocol), safety outcomes, clinical success, and radiological success. Statistical analyses were performed using a random-effects model, with heterogeneity assessed via the I² statistic.</p> Results <p>Fourteen studies (925 patients; 33.6% men; mean age: 46.6&#xa0;years) with 1,010 GHHs were included. The overall technical success rate for thermal ablation was 99.95%, with a major complication rate of 2.21%. Clinical success, defined as symptom resolution or significant improvement, was achieved in 99.85% of patients, while radiological success, defined as at least a 50% reduction in lesion size, was observed in 89.81%. Minor complications were reported in 48.88%, and total complications in 52.43%, while procedure-related morbidity was low at 0.34%. In the subgroup analysis, radiological success was 95.6% in the MWA group and 86.3% in the RFA group (<i>p</i> = 0.073). Major complication rates were 1.99% for MWA and 2.08% for RFA (<i>p</i> = 0.93), while total complication rates were 46.0% and 58.1%, respectively (<i>p</i> = 0.43).</p> Conclusion <p>MWA and RFA are highly effective and safe options for treating GHHs, with excellent technical and clinical success rates. MWA may offer advantages in radiological success and lower complication rates.</p>