Open adrenalectomy is considered a standard operative approach for adrenocortical carcinoma, and laparoscopic adrenalectomy remains controversial. We analyzed our outcomes of laparoscopic adrenalectomy and open adrenalectomy for localized (stage 1/2) adrenocortical carcinoma in our hospital. This study retrospectively reviewed all patients with stage 1/2 adrenocortical carcinoma and a tumor size < 10 cm who underwent radical resection in our hospital between 2009 and 2017. These patients were divided into laparoscopic adrenalectomy and open adrenalectomy groups. Demographics, operative data, and follow-up outcomes were collected. The 5-year overall survival and recurrence-free survival were calculated with the Kaplan-Meier method and compared between laparoscopic adrenalectomy and open adrenalectomy group. A total of 23 patients operated by an open adrenalectomy and 21 patients operated with a laparoscopic adrenalectomy were included. Baseline patient characteristics (age, sex, tumor size, hormonal secretion) were similar between 2 groups. The mean postoperative stay was less in the laparoscopic adrenalectomy group (P = .003). The mean follow-up time was similar for the two groups (33 ± 24 vs 35 ± 25 months; P = NS). The local and peritoneal recurrence rates were 42% for laparoscopic adrenalectomy and 22% for open adrenalectomy (P = .035). Time to local and peritoneal recurrence was less in the laparoscopic adrenalectomy than in the open adrenalectomy (P = .048). The 5-year overall survival and recurrence-free survival for open adrenalectomy versus laparoscopic adrenalectomy were 43% vs 47% (P = .635) and 36% vs 39% (P = .802), respectively. We believe that open adrenalectomy should still be considered the standard operative management of adrenocortical carcinoma. Laparoscopic adrenalectomy may not provide patients with localized adrenocortical carcinoma with an equivalent oncologic outcome based on site and timing of initial tumor recurrence. Copyright © 2018 Elsevier Inc. All rights reserved.