Background and Aims Small cell carcinoma of the gallbladder (SCCG) is a rare neuroendocrine carcinoma. At present, there is a lack of evidence of clinical research with large sample size for this group of patients, and also the prognostic value of surgical treatment is still unclear. The purpose of this study was to evaluate the prognostic value of surgical treatment in SCCG.Methods The clinical data of patients with pathologically diagnosed SCCG from 2000 to 2018 were extracted from SEER database. According to the inclusion and exclusion criteria, a total of 116 cases were included after strictly screening. The patients were divided into operation group and non-operation group according to whether they received surgery or not. The differences in cancer-specific survival (CSS) and overall survival (OS) between the two groups were compared, and the influencing factors for CSS and OS were analyzed.Results The median age of the included patients was 64 years old (IQR: 54-75 years), and 30.17% (35/116) of patients were men. There were 63 cases (54.31%) in the operation group and 53 cases (45.69%) in the non-operation group. The median follow-up was 9 months (IQR: 3-19.5 months). Of the 63 patients in the operation group, 45 died (71.43%), including 42 tumor-related deaths (66.67%). Of the 53 patients in the non-operative group, 48 died (90.57%), including 44 tumor-related deaths (83.02%). The estimated 1-year OS of operation group and non-operation group were 62.40% and 23.70%, and the estimated 1-year CSS of operation group and non-operation group were 64.81% and 26.08%, respectively. There were significant differences between the two groups (χ²=19.75 and χ²=8.53, both P<0.001). Results of multivariate prognostic analysis by Cox proportional hazard mode showed that age, presence or absence of hepatic metastasis, receiving surgical treatment or not, and receiving radiotherapy or not were independent influencing factors for OS, and presence or absence of hepatic metastasis, receiving surgical treatment or not, and receiving radiotherapy or not were independent influencing factors for CSS (all P<0.05). The OS (HR=0.54, 95% CI=0.33-0.89, P=0.017) and CSS (HR=0.52, 95% CI=0.31-0.87, P=0.014) in SCCG patients were significantly improved by surgical treatment. Stratified analyses based on clinicopathologic characteristics showed that surgical treatment significantly improved the OS in patients with age <60 years (HR=0.14, 95% CI=0.05-0.38, P<0.001), female sex (HR=0.45, 95% CI=0.25-0.81, P=0.008), unmarried status (HR=0.41, 95% CI=0.17-0.94, P=0.037), and no presence of hepatic metastasis (HR=0.16, 95% CI=0.04-0.67, P=0.012), or patients not receiving radiotherapy (HR=0.56, 95% CI=0.32-0.96, P=0.037), and undergoing chemotherapy (HR=0.33, 95% CI=0.17-0.63, P<0.001); surgical treatment significantly improved the CSS in patients with age <60 years (HR=0.14, 95% CI=0.05-0.38), P<0.001), female sex (HR=0.43, 95% CI=0.23-0.80, P=0.008), unmarried status (HR=0.31, 95% CI=0.12-0.79, P=0.013), and no presence of hepatic metastasis (HR=0.13, 95% CI=0.02-0.69, P=0.017), or patients not receiving radiotherapy (HR=0.51, 95% CI=0.29-0.90, P=0.022),and undergoing chemotherapy (HR=0.35, 95% CI=0.18-0.67, P=0.002).Conclusion Surgical treatment can improve the OS and CSS in SCCG patients, especially in those with age <60 years, female sex, unmarried status, and without hepatic metastasis or radiotherapy, or having chemotherapy.