Lymph node metastasis of adrenocortical carcinoma is usually not treated surgically, but when the patient develops uncontrollable severe hypercortisolism or has urgent compression symptoms, surgery may be considered. Lymph node metastasis of adrenocortical carcinoma belongs to the advanced stage of the tumor, and surgery is usually not advocated, and even after surgery, tumor dissemination, bleeding, delayed healing of incision and serious impact on the quality of patient’s survival may occur. Therefore, lymph node metastasis of adrenocortical carcinoma is usually not recommended to be treated by surgery, and chemotherapy and radiotherapy are often adopted. However, if the primary and metastatic foci can be completely resected, or if the patient has uncontrollable severe hypercortisolism or if the tumor compresses the surrounding tissues and organs and causes serious symptoms, palliative subtotal surgery can be performed, which can help to control the complications of excessive hormone secretion and relieve the compression symptoms of the tumor. Patients with lymph node metastasis of adrenocortical carcinoma should go to the hospital in time and choose the appropriate treatment plan under the advice and guidance of doctors.