Resection of Colorectal Cancer Metastasis

The objective of this chapter is to familiarize pathologists with the essential components of surgical pathology reports for colorectal liver metastasis (CRLM) resections. The liver is the most frequent site of metastases, and patients often have resections after receiving neoadjuvant chemotherapy. Patients are commonly treated with oxaliplatin- (e.g., FOLFOX: 5-FU/leucovorin and oxaliplatin) and irinotecan- (e.g., FOLFIRI: 5-FU/leucovorin and irinotecan) based regimens. Comprehensive pathology reports should include more information than just margin status. Details regarding the tumor’s response to treatment, molecular features of the cancer, and evidence of chemotherapy-related injury, if present, should also be included. If molecular studies have not been conducted, they should be ordered on the resection specimen. This chapter will include practical approaches to assist surgical pathologists in working up and reporting these challenging cases.