Objective To compare perioperative and oncologic outcomes between laparoscopic (LCA) and percutaneous cryoablation (PCA) and identify predictors of treatment failure after cryoablation. Methods Retrospective analysis was performed on 145 patients undergoing LCA and 118 patients undergoing PCA at our institution between July 2000 and June 2011. Results LCA and PCA were performed on 167 and 123 tumors, respectively. Perioperative complication rates were 10% for both the groups. Mean length of stay was significantly shorter for the PCA group (2.1 ± 0.5 vs 3.5 ± 3.1 days, P <.01). Both groups had a comparable decline in estimated glomerular filtration rate at most recent follow-up (LCA 3.8 ± 18.5 mL/min/1.73 m2 vs PCA 6.6 ± 17.1 mL/min/1.73 m2, P =.21). Mean oncologic follow-up was 71.4 ± 32.1 months for LCA and 38.6 ± 19.6 months for PCA. Kaplan-Meier estimated 5-year overall and recurrence-free survival were 79.3% and 85.5%, respectively, for LCA and 86.3% and 86.3%, respectively, for PCA. Multivariate Cox proportional hazards analysis demonstrated that cryoablation approach (LCA vs PCA) was not predictive of overall mortality or disease recurrence (P =.36 and.82, respectively). Predictors of overall mortality included age-adjusted Charlson comorbidity index ≥6 (P =.01) and preoperative estimated glomerular filtration rate <60 mL/min/1.73 m2 (P =.02). Predictors of recurrence included tumor size ≥3 cm (P <.01), body mass index ≥30 kg/m2 (P =.01), and endophytic growth (P =.04). Conclusion Mean length of stay was shorter for patients undergoing PCA as compared with LCA. Complication rates and decline in renal function at most recent follow-up were similar between groups. Oncologic outcomes were influenced by baseline patient and tumor characteristics rather than the cryoablation approach.