In order to investigate the lethality of carcinoma of the gallbladder and several of the coexisting features, a retrospective analysis of 53 patients with this disease was undertaken. Abdominal pain, obstructive jaundice, and a right upper quandrant mass were present in approximately one-half of the patients. Laboratory and radiological data were frequently nonspecific and did little to identify the diagnosis. The most common preoperative diagnoses were cholelithiasis or chronic cholecystitis. Cholecystectomy was the most frequently performed procedure. Fifteen wedge liver resections were performed. No radical or extended liver resections were done. Eighty-one percent of the patients had sufficient data for staging. Five patients (11.6%) had stage I lesions, three patients (7.0%) had stage II lesions, while 17 (39.5%) and 18 (41.9%) patients had stage III and IV lesions, respectively. Mean survival was 6.4 months for the entire group. Three patients are still alive (two longer than 5 years and one at 2 years) for an overall survival of 5.7%. Both staging and grading of the tumor correlated well with patient survival. Those patients with stage I lesions survived significandy longer (23 months vs. 3 months) than those with stage IV tumors. Also, those with more favorably graded (well-differentiated) neoplasms lived an average of 13 months longer than patients with poorly differentiated lesions.