Objective: The objective of this study was to investigate whether radical surgical treatment can be associated with reasonable survival for patients with Stage IV gallbladder cancer with distant lymph node metastasis. Methods: Fifty-five patients (20 men and 35 women) with complete clinical and follow-up data for Japanese Society of Biliary Surgery TNM system Stage IV gallbladder cancer were included in our study. Patients were divided into three treatment groups for clinical analysis: Group A (radical resection, n = 24), Group B (chemotherapy, n = 8) and Group C (other palliative treatment, n = 23). Results: The survival rate in Group A was significantly higher when compared with Groups B (P = 0.008) and C (P = 0.004). Moreover, the prognosis of patients with distant lymph node metastasis (Group A2, Japanese Society of Biliary Surgery N3; American Joint Committee on Cancer M1) was significantly worse versus those with local lymph node metastasis (Group A1, Japanese Society of Biliary Surgery N1-N2; American Joint Committee on Cancer N1) (P = 0.007). Most importantly, no significant difference in the survival rate was observed between patients in Group A2 and Groups B (P = 0.47) or C (P = 0.74). Conclusions: Radical resection might result in a reasonable prognosis for gallbladder cancer patients with local metastasis of the lymph nodes (Japanese Society of Biliary Surgery N1-N2), but was not effective when distant lymph nodes (Japanese Society of Biliary Surgery N3) were involved.