Delayed formation of gallstone after transcatheter arterial embolization for hepatocellular carcinoma. Is elective cholecystectomy advisable during hepatectomy?

Two hundred twenty-five transcatheter hepatic arterial embolizations (TAEs) were performed on 137 patients with hepatocellular carcinoma (HCC) during a three-year period. The postembolization changes of the gallbladder were studied by regular follow-up with ultrasonography. Twenty-four patients (10.7%) were found to have an acute infarction of the gallbladder within two weeks immediately following chemoembolization. Gallbladder infarction was related to inadequate superselectivity, regurgitation of chemoembolus, or unavoidable anatomic limitations. Four of the 24 patients were found to have delayed formation of gallstones, with the time lapses after TAEs being 2, 2, 3, and 5 months, respectively. One patient underwent surgical reexploration for cholecystectomy 14 months after resection of her HCC because of intractable symptoms and signs of chronic cholecystitis. There are four possible mechanisms of development of gallstones. Cholecystectomy should be performed during the elective hepatectomy for resectable HCC in patients who have received preoperative TAEs.