The records of 45 patients with carcinoma of the gallbladder who had undergone surgical resection at least 5 years previously were reviewed retrospectively to determine which factors influence long-term survival. Seventeen patients survived at least 5 years and 23 died from recurrence (five patients were excluded from analysis). Of the 17 long-term survivors 15 had tumours superficial to the subserosa that showed a non-infiltrative growth pattern. Those alive at 5 years were more likely than short-term survivors to have tumours that were papillary (P < 0.05) or well differentiated (P < 0.01) adenocarcinoma. Venous, lymphatic and perineural invasion was more common in short- than in long-term survivors (87 versus 29 per cent, P < 0.001). Patients with tumours limited to the muscularis and those with non-infiltrative subserosal involvement are likely to have better survival and may have a chance of cure after extended cholecystectomy.