Purpose: Certain rectal cancer patients with metastatic disease at time of diagnosis are candidates for curative intent treatment. This study reports on this patient group's outcomes and describes the treatment's timing and modalities. Methodology: A retrospective cohort study was conducted on all rectal cancer patients with Stage IV disease treated with curative intent at a Western Australian tertiary hospital from 2004 to 2023. Clinicopathological and survival data were analysed in SPSS ver.29 Results: Seventy-one patients were included. Thirty-two (45.1%) had isolated liver metastasis, 16.9% (n=12) had isolated lung metastasis, and 38.0% (n=27) had metastases to both. Compared to those with exclusively liver metastases, patients with lung metastases only had higher all-cause (50.0% vs 58.3%) and slightly higher cancer-specific (41.7% vs 40.6%) mortality at 5 years. Comparatively, dual organ metastasis carried the worst cancer-specific mortality (77.8%, p=0.010). Isolated lung metastases were mostly ablated rather than resected (75% vs. 25%), though a superior 5-year recurrence-free survival (RFS) was observed in the latter (60% vs. 40%, p=0.167). Conversely, liver metastases were more likely to be resected than ablated (78.1% vs. 29.1%), with formal resection conferring a slightly better 5-year RFS (27.3% vs. 20%, p=0.738). Conclusion: Isolated metastasis to the lungs has a poor prognosis compared to the liver. In this study’s experience, formal resections outperformed ablation therapies in terms of survival. These findings provide insight into how the site of oligometastatic disease can influence management and prognosis in stage IV rectal cancer patients.