We investigated 36 patients with Stage Ⅳ rectal cancer who underwent primary resection in our department between November 2015 and June 2020. Tumor localization was upper in 20 cases and lower in 16 cases. Six patients had the cT4b stage at initial diagnosis, and lateral lymph node metastases were detected in 6 cases. Preoperative treatment consisted of doublet chemotherapy in 20 cases, in combination with bevacizumab in 17 cases. Surgery for distant metastases was performed in 21 patients, and the final results were curative(Cur B)in 20 patients and palliative(Cur C)in 16 patients. Perioperative mortality was observed only in Cur C patients(5.6%). The local R1 resection rates in Cur B and Cur C patients were 10.0% and 18.8%, respectively, and the corresponding local RM≤1 mm rates were 55.0% and 43.8%. Additionally, the local recurrence rates were 25.0% and 0%, and the 3-year OS rates were 80.9% and 25.5%, respectively, in Cur B and Cur C patients. In Cur B, the local RM≤1 mm rates in the preoperative and non-preoperative treatment groups were 38.5% and 85.7%, respectively, and the corresponding local R1 resection rates were 7.7% and 14.3%. Additionally, the 3-year local recurrence-free survival rates were 68.2% and 66.7% and the 3-year OS rates were 82.1% and 80.0%, respectively, in the preoperative and non-preoperative treatment groups. We determined that preoperative chemotherapy alone is not sufficient for the local treatment of Stage Ⅳ rectal cancer, and concomitant preoperative radiotherapy should be considered. The prognosis of patients with Cur C is poor, and surgery-related deaths have been observed, which can be a problem for the palliative resection strategy.