Gallbladder cancer is often described as extremely aggressive with a poor prognosis. Most patients with early-stage gallbladder cancer are asymptomatic and will not be diagnosed until late in the disease course, contributing to gallbladder cancer’s generally poor 5-year survival. While gallbladder cancer is the most common biliary cancer, it is relatively rare in developed countries, and few prospective studies on its management exist. At this time, surgery remains the mainstay of treatment, followed by adjuvant chemoradiation. The operative procedure of choice depends on the patient’s presentation and tumor stage. For early-stage tumors (Tis and T1a), simple cholecystectomy can be curative. In more advanced disease, radical cholecystectomy must be performed. Surveillance includes an evaluation and updated cross-sectional imaging every 3–6 months for 2 years and 6–12 months for an additional 3 years after surgery. Despite ideal surgical management, disease recurrence within 24 months is common. The majority of recurrences have a metastatic component with or without local recurrence.