The treatment of adrenal cortical cancer mainly relies on surgery. With the development of minimally invasive techniques, adrenal surgery through laparoscopic techniques has been rapidly developed. Tumors with a diameter of 10 cm or even more can be removed minimally invasively through laparoscopy. Of course, the way of surgery and the risks need to be discussed with the surgeon in person. Some patients wonder if the chance of surgery is lost when the tumor has metastasized. The answer is no. We will evaluate the benefit of surgery to the patient through clinical data to decide whether and how to operate. However, even if the tumor has not metastasized, there is still a learning curve in the surgical management of adrenocortical carcinoma alone, such as how to deal with the squeezed kidney? How to deal with the compressed inferior vena cava and so on also need to be analyzed on a case-by-case basis. It is worth noting that some patients need to remove the ipsilateral kidney. Of course, for some patients who are not eligible for surgery, there are some medication and chemotherapy options available to relieve symptoms and improve quality of life.