Early Detection of Treatment Failure in Metastatic Colorectal Cancer Patients

Inclusion Criteria: 1. Male or female patients (≥18 years of age at the time of consent); 2. Stage IV colon or rectal adenocarcinoma with liver-restricted metastasis(es) for whom partial hepatectomy with curative intent is planned; 3. Instead of, or in addition to, partial hepatectomy, liver metastases may be ablated by needle radio frequency or microwave; in case of a solitary liver metastasis, three core-needle biopsies are provided for research at time of the procedure and prior to tissue destruction; 4. Patients may undergo planned two-stage partial hepatectomies; 5. Patients may have at baseline lung micro nodules or intra-abdominal enlarged nodes or nodules of unknown nature, not considered as extra-hepatic metastases in the opinion of the investigator; 6. Patients who are scheduled to receive FOLFOX-based pre-hepatectomy may receive any additional combined agents, such as and not limited to Irinotecan, anti-EGFR, and anti-VEGF drugs; 7. Patients are willing and able to provide serial blood samples, tumor and adjacent tissues, and stool samples for research; 8. The timing and specific treatments of the primary colon or rectal tumor is per SOC, at the discretion of the treating physician, including the use of pre-operative radiotherapy for rectal cancer; 9. Patients may receive post-operative adjuvant chemotherapy per SOC, at the discretion of the treating physician; 10. Patients must consent to the Exactis Personalized my Treatment registry. Exclusion Criteria: 1. Pregnant or breastfeeding patients, 2. Hereditary colorectal cancer (e.g., familial colonic polyposis or Lynch syndrome), and 3. Presence of concurrent other cancer(s).