Adrenocortical carcinoma is an extremely malignant tumor with a low incidence of 0.02% of malignant tumors. Since 30% to 85% of ACC patients have distant metastases at the time of diagnosis, most of them survive for less than 1 year. Even the 5-year survival rate of surgically resected stage I-III patients is only about 30%. For early stage adrenocortical carcinoma, surgical resection is very important: 1) complete resection of the tumor including the surrounding adipose tissue, suspected tumor invasion area and lymph nodes; 2) resection of the whole block with the primary foci, such as kidney, spleen, liver, etc. for near organ involvement. For adrenal tumors larger than 5cm, if adrenocortical carcinoma is considered, it is better to choose open surgery to completely remove the tumor and its surrounding tissues, and to remove the related tissues and organs at the same time if it adheres to the surrounding tissues. Our center has treated many patients who recurred after laparoscopic minimally invasive surgery to remove adrenocortical carcinoma, because the lesion ruptured during surgery or was not completely removed, and these patients basically died within 1-2 years. Because the tumor tissue of cortical cancer is as brittle as tofu, it is easy to rupture during surgery, so the principle of tumor-free, surgical technique and experience are decisive for the life and death of patients.