We report a case of rectal cancer with distant metastases, which was successfully treated with multidisciplinary treatments. The 60s female underwent an abdomino-perineal resection (APR) for low rectal cancer. One year after the APR, two hepatic metastases were found and initially treated by radiofrequency ablation and later by hepatectomy. One month after the hepatectomy, three pulmonary metastases of 10 mm in diameter were found in the right lung. Several regimens of chemotherapy (S-1, CPT-11 and FOLFOX6) were performed. After 3 years of chemotherapy, pulmonary metastases re- grew in size but no new lesion developed. Pneumonectomy was performed to remove all metastatic tumors. A half year after the initial pneumonectomy, a new metastasis was found in the left lung, which was again removed by surgery after 6 months of observation. Postoperative course was uneventful, and she is alive without recurrence for 7 years since the initial rectal surgery.