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Introduction: Most patients undergoing liver resection for colorectal liver metastases develop recurrent hepatic disease. In this setting, complete resection is often technically difficult or impossible. This study evaluates the role of intraoperative ablation as an adjunct to resection in patients with recurrent colorectal liver metastases.Methods: A retrospective cohort study was performed using a prospectively collected database. The study population included patients who underwent curative reoperative surgery for recurrent colorectal liver metastases from 1991-2009. Patients were categorized based on whether they were treated with resection alone (RES) or in combination with ablation (COMB). The groups were compared with respect to tumor factors, perioperative factors and overall survival. Multivariable Cox regression models were used to examine overall survival while adjusting for confounding variables.Results: A total of 234 operations were performed on 104 patients. The median number of operations performed per patient was 2 (range 2-4). There was an increase in the proportion of patients treated with resection and ablation from 0% (1991-1994) to 48% (2007-2009). There was also an increase in the proportion of patients undergoing surgery with abnormal liver parenchyma (steatosis, fibrosis or inflammation) from 37.5% (1992-1994) to 52.2% (2007-2009). Patients undergoing resection and ablation had a greater tumor burden (median 3 metastatic lesions vs. 1, p<0.0001) and higher baseline clinical risk scores (median 3 vs. 2, p=0.041) than patients undergoing resection alone. Patients undergoing resection and ablation had lower intraoperative blood loss compared to patients undergoing resection alone (312±48 mL vs. 860±99mL, p=0.0060). At a median followup of 54 months, 5-year overall survival from the time of first liver metastasis was 47.4%, with no significant difference between the RES and COMB groups in univariate (5-year survival 46.6% RES vs. 59.6% COMB, p=0.86) or multivariable analysis (HR: 0.94, 95%CI: 0.30 to 2.93, p=0.91).Conclusion: In patients with recurrent colorectal liver metastases, the combination of intraoperative ablation with resection extends the limits of potentially curative therapy to include patients with advanced disease that might otherwise not be amenable to surgical intervention. The combination of resection and ablation yields survival results that are equivalent to that of resection alone but with reduced surgical morbidity.