Gallbladder cancer (GBC) is associated with poor survival because of advanced disease stage at presentation. Although the best chance of cure for GBC remains incidental discovery, radical resection of the gallbladder, with adjacent liver, adherent structures, and a regional lymphadenectomy has been purported to improve survival. We retrospectively analyzed all patients with GBC who were treated surgically in our institution between 1984-2000. There were 126 patients (92 women, 34 men) for whom complete survival information was available. Stage distribution was: Stage 0: 1; Stage I: 4; Stage II: 15; Stage III: 39; Stage IVA: 17; Stage IVB: 48; unknown: 2. Fifty-seven patients had radical cholecystectomy, 46 patients had a simple cholecystectomy, and 23 patients had other surgical treatments. Forty-seven patients had some form of adjuvant therapy. Patients who underwent a radical cholecystectomy had a significantly longer mean survival (mean = 29.9 months) than those patients who had simple cholecystectomy (mean = 9.3 months, p= 0.0001) or other treatment (mean = 5.4 months, p< 0.0001). The radical cholecystectomy group had significantly longer survivals than simple cholecystectomy group for Stage III (mean = 35 vs. 7.6 months, p=0.01), Stage IVA (mean = 12.5 vs. 3.2 months, p=0.012), and Stage IVB (mean = 23.5 vs. 5.8 months, p<0.001). Adjuvant therapy significantly improved survival in Stage IVB patients treated with simple cholecystectomy (n=3, mean = 10.1 months) compared to simple cholecystectomy alone (n=14, mean = 4.9 months, p=0.03). Although adjuvant chemotherapy appeared to improve survival for other GBC stages or treatment modalities, these effects did not reach statistical significance. Of the different variables tested by multivariate analysis (age, sex, radical and simple cholecystectomy, stage and grade of tumor), only radical cholecystectomy, and T and N tumor stage were statistically significant predictors for the survival of patients with GBC. We conclude that radical cholecystectomy is associated with improved patient survival and is recommended for patients with locally advanced GBC.