【Abstract】 Objective To analyze the prognostic factors in patients with stage IV GBC, and identify benefit from R0 resection. Methods Clinicopathologic features and survival outcomes were analyzed in 285 GBC patients underwent surgery between 2008 and 2012.Results The 1, 2and 3year over all survival rates were 79%, 22%, and 08%, respectively. More than 65 years old, M1 status, R1/2 resection were independent risk factors affecting GBC prognosis. The mean survival time (MST) was significantly higher in patients underwent R0 resection compared with R1/2 resection (6.0 vs 2.7 months; P＜ 0.001). Stage IVA patients benefited from R0 resection (MST for R0 vs R1/2, 11.0 vs 3.7 months; P=0.038), while R0 resection provided a significant survival benefit over R1/2 resection in stage IVB patients without distant metastasis (MST for R0 vs R1/2, 6.0 vs 3.0 months; P= 0.004). Conclusion N2 lymph node metastasis does not preclude curative resection. R0 resection should be considered in highly selected stage IV GBC patients.