Gallbladder cancer is the most common malignant tumor of the biliary system, characterized by insidious growth, rapid progression, and skip metastasis. The 5-year overall survival rate is only 5%. Although targeted immunotherapies have emerged in recent years, they are still in the exploratory phase for the treatment of gallbladder cancer, and radical surgical resection remains the only potentially curative treatment. The main goal of surgery is to completely remove the tumor and perform systematic lymph node dissection to reduce the risk of recurrence. Thanks to advances in surgical techniques and continuous optimization of perioperative management, postoperative complications, and hospital mortality in patients undergoing extended radical surgery for gallbladder cancer have decreased. However, the complex mechanisms of gallbladder cancer spread and metastasis make it challenging to determine the optimal scope of surgical resection. Clinical guidelines from different countries and hepatobiliary surgery centers often vary on surgical options, especially regarding the reasonable extent of liver resection, the scope of lymph node dissection and its impact on prognosis, and whether routine extrahepatic bile duct resection should be performed. There remains significant controversy in these areas. Future extensive prospective cohort studies are still needed to provide more evidence-based medical data for the surgical treatment of gallbladder cancer. When designing a surgical plan, surgeons must consider preoperative examination results, intraoperative findings, and pathological evaluation of frozen sections. A balance must be struck between radical treatment and safety and effectiveness. The most appropriate surgical method for each patient should be chosen while also emphasizing establishing a multidisciplinary collaborative system. Based on accurate tumor staging, postoperative adjuvant therapies should be integrated to continue making progress in improving patient prognosis.