A-66-year-old male was referred to our hospital for Stage IV (cT4N3M1a) adenocarcinoma of the right middle lobe. Although the chemotherapy with carboplatin, pemetrexed, and bevacizumab was effective, it was finished in 3 courses because of poor tolerability, and he underwent a partial resection of the right middle and lower lobes and the diaphragm. More than 90% of the primary lesion showed fibrosis and remaining cancer cells, some of which expressed Ki67, that were surrounded by abundant lymphocytes. All of the other resected metastatic lesions showed fibrosis with no survival of cancer cells. Followed by two courses of adjuvant chemotherapy, he is now under observation in the state of PS-0 without recurrence for 9 months. Before 2nd line chemotherapy, salvage surgery may also need to be taken into consideration as one means of the multimodal therapy for stage IV non-small cell lung cancer if the case is chosen appropriately.