Background <p>Laparoscopic resection is the standard treatment for resectable colorectal liver metastases (CRLM). While the safety profile using combined ablation and resection (CARe) to treat CRLM has been documented, its efficacy has not been compared with that of resection alone in the laparoscopic setting. The aim of this study was to compare the short- and long-term outcomes of laparoscopic CARe with those of laparoscopic resection alone for multiple CRLM.</p> Methods <p>Patients with multiple CRLM who underwent laparoscopic resection at three medical centres from 2018 to 2023 were included. Perioperative and oncological outcomes were compared between the two groups. Propensity score matching (PSM) was performed.</p> Results <p>Of the 218 included patients, 67 (30.7%) underwent laparoscopic CARe, and 151 (69.3%) underwent laparoscopic resection alone. After PSM, 49 matched pairs of patients were included for each group. The postoperative complication rate was similar between the two groups (<i>P</i> = 0.964). The median recurrence-free survival (RFS) (11.8 vs. 12.1&#xa0;months, <i>P</i> = 0.759) and overall survival (OS) (not reached, <i>P</i> = 0.656) were not significantly different between the two groups. Multivariate analysis revealed that ≥ 4 CRLM [hazard ratio (HR) = 1.86, 95% confidence interval (CI) 1.09–3.15, <i>P</i> = 0.022] and synchronous metastases (HR = 2.00, 95% CI 1.21–3.31, <i>P</i> = 0.007) and was independently associated with RFS, whereas bilobar distribution (HR = 3.20, 95% CI 1.04–9.82, <i>P</i> = 0.042) was independently associated with OS. No statistically significant differences were observed in the timing of recurrence (<i>P</i> = 0.666), the site of recurrence (<i>P</i> = 0.279), or the treatment administered after recurrence (<i>P</i> = 0.641) between the two groups.</p> Conclusions <p>Laparoscopic CARe may be considered as a useful treatment strategy for multiple CRLM.</p> Graphical abstract <p></p>