Objective: To discuss the diagnosis and treatment of incidental gallbladder cancer (IGC) during laparoscopic cholecystectomy. Methods: The clinical data of 23 patients with IGC admitted to our hospital from January 1998 through January 2007 were retrospectively analyzed. Results: Fifteen patients were identified as gallbladder cancer by intraoperative frozen-section examination, 13 of them were converted to open radical resection; 8 patients were diagnosed by postoperative pathology, 7 of whom underwent a secondary open surgery. The postoperative 5-year survival rate of the entire group was 78.3%, and the prognosis of IGC was closely related to the TNM stages. Conclusion: Incidental gallbladder cancer is often in early stage, attention should be paid to the specimen examination and intraoperative fast frozen-section in the high-risk patients. The extended radical operation is preferred for patients with T1b–T2 tumors, and for the advanced stage cases, whether to perform radical operation or palliative procedures may depend on the individual’s condition.