DRG Category: 412

Mean LOS: 8.4 days

Description SURGICAL: Cholecystectomy with C.D.E. with CC

DRG Category: 415

Mean LOS: 7.3 days

Description SURGICAL: Cholecystectomy Except by Laparoscope without C.D.E. with CC

DRG Category: 436

Mean LOS: 5.6 days

Description MEDICAL: Malignancy of Hepatobiliary System or Pancreas with CC

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Gallbladder cancer and biliary duct cancer are relatively rare and account for fewer than 1% of all cancers. In 2008, there were an estimated 9,520 new cases of gallbladder and ductal cancer diagnosed. The average age of diagnosis is 73 years. Of those diagnosed, 3,340 people died from the disease. Most cancers of the gallbladder and biliary tract are inoperable at the time of diagnosis. If the cancer has been found incidentally at the time of a cholecystectomy, longer survival may be possible. More than 75% of gallbladder cancers are nonpapillary adenocarcinomas, and approximately 6% are papillary adenocarcinomas; a small number are squamous cell, adenosquamous cell, mucinous, or small cell carcinomas. Papillary cancers have a better prognosis and grow along the connective tissue and blood vessels; they are not as likely to metastasize to the liver and lymph nodes. Adenocarcinomas occur most frequently at the bifurcation in the common bile duct.

Biliary system cancer is insidious and metastasizes via the lymphatic and blood systems and by direct extension to the liver, pancreas, stomach, and duodenum. Invasion of the gastrointestinal (GI) tract can cause complete obstruction of the extrahepatic bile ducts with intrahepatic biliary dilation and enlargement of the liver. If the tumor is restricted to one hepatic duct, biliary obstruction is incomplete and jaundice may not be present. Inflammatory disorders such as cholangitis (bile duct inflammation) and peritonitis often obscure an underlying malignancy. Infection often accompanies cancer of the gallbladder, and bile duct cancers are associated with ulcerative colitis. In most patients with gallbladder and biliary cancer, the disease progresses rapidly and patients usually survive little more than a year after diagnosis.