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This study aimed to clarify the histological characteristics related to preoperative chemotherapy for colorectal liver metastases ( CRLM ). Sixty‐three patients with  CRLM  were divided into two groups:  CRLM  with chemotherapy (41 cases, group  A ) and  CRLM  without chemotherapy (22 cases; surgical treatment alone, group  S ) to identify the histological differences associated with chemotherapy. In addition, we investigated the effects of combination chemotherapy on the histology of metastatic lesions. Infarct‐like necrosis ( ILN ), three‐zonal changes, and cholesterol clefts were more frequent in group  A  than in group  S  ( P  < 0.05).  ILN  and three‐zonal changes were more common in the 5‐FU with leucovorin and oxaliplatin ( FOLFOX ), or 5‐FU with leucovorin and irinotecan ( FOLFIRI ) with or without additional bevacizumab groups than in group  S  ( P  < 0.05). Cholesterol clefts in the  FOLFOX  or  FOLFIRI  with bevacizumab group and foamy macrophages in the  FOLFOX  or  FOLFIRI  group were more common than in group  S  ( P  < 0.05). Cases with more than three of the four histological findings—i.e.  ILN , three‐zonal changes, cholesterol clefts, and foamy macrophages—were more frequent in the  FOLFOX  or  FOLFIRI  with or without additional bevacizumab groups than in group  S  ( P  < 0.05). We showed histological findings for every representative chemotherapy regimen for  CRLM  to clarify the effects of preoperative chemotherapy.

Proposal for novel histological findings of colorectal liver metastases with preoperative chemotherapy