BACKGROUND: To report management and survival outcomes of gallbladder cancer (GBC) in the United Kingdom and to identify prognostic factors associated with disease-free survival (DFS) and overall survival (OS). METHODS: Patients undergoing surgery for GBC between January 2014 and December 2022 across 24 UK centres were included. Demographic, treatment, histopathological, and survival data were analysed. RESULTS: 516 patients underwent surgery for GBC, with a median follow-up of 25 months. Patients with T3-T4 tumours more frequently presented with jaundice, had non-incidental disease, and underwent major hepatectomy compared with those with T1-T2 tumours. Advanced stage, nodal metastasis, vascular invasion, and perineural invasion were more common in patients undergoing major hepatectomy, which was also associated with higher major morbidity and 30-day mortality. Propensity score-matched analysis demonstrated no significant benefit in DFS or OS among patients who received adjuvant therapy compared with those who did not. On multivariable analysis, T3-T4 stage, nodal disease, and perineural invasion predicted poorer DFS, while T3-T4 stage and nodal disease predicted worse OS. DISCUSSION: This nationwide study demonstrates the evolution of management practices for GBC in the UK. Adverse tumour biology remains the principal determinant of survival following surgery for GBC.