AbstractA clinical and pathological review of 68 patients with a primary carcinoma of the gallbladder was undertaken. A prolonged preceding history of biliary disease was noted. Preoperative radiological and biochemical investigations were not helpful, but an isolated elevation in serum alkaline phosphatase level in the absence of any biliary obstruction or hepatic dysfunction was noticed in some patients. The significance of stones in relation to pathogenesis is discussed. A more radical surgical approach involving a partial hepatectomy appears to be the only possible treatment in view of the mode of spread of this tumour and the bad overall prognosis.