Background: Pulmonary metastasis (PM) from colorectal cancer (CRC) is a rare and incompletely understood entity which affects 10% of CRC patients. The 5-year overall survival (OS) of Stage IV CRC is 11.3% and in pulmonary metastatectomy range from 40% to 69.7%. This study aims to evaluate the overall 5-year survival of PM from CRC and identify potential independent risk factors affecting the OS. Methods: A retrospective study was conducted in a tertiary care center (Royal Hospital). The study included all patients diagnosed with Stage IV CRC with PM aged >18 years between 2008 and 2015. Patients with no follow-up and missed data were excluded. Data were retrieved from the electronic record system (Al-Shifaa) and analyzed using SPSS software. Results: The prevalence of PM in the overall CRC cases was 15.2% (84/554 patients). Seventy-one patients were included in this study after the application of exclusion criteria with the mean age of patients was 60.35 ± 16.4 years; majority male gender 64.8% (46) and most of them with no comorbidities 57.7% (42). The most common location of primary tumor is sigmoid 31% (22) and diagnosed with T3 40.8% (29) status and N2 32.4% (23) status with high CEA > 5 at presentation and diagnosis. The majority of cases presented with synchronous PM 74.6% (53) and following metastasis features bilateral lung side 69.0% (49), =>10 nodules 42.3% (30), <1 cm size 66.2% (47), and no lymph involvement 57.7% (41). Five-year OS rate is 15.3%, and the median OS time is 15 months. There was a statistically significant difference in the OS distribution between those who received surgery and those who did not receive surgery (Log-rank test, P = 0.004) and 5-year OS rate in the surgical group is 55.6% versus 8.3% in nonsurgical. Median survival time was 71 months versus 13 months, respectively. Several factors were found to be associated with a favorable OS, which include the middle age group (P = 0.007), absence of perineural invasion (P = 0.015), and isolated PM (P = 0.003). In addition, multivariate Cox regression showed OS relatively poor in females (P0.001), metachronous (0.003), T4 (0.005), and normal CEA at diagnosis (0.011). Conclusion: The present study showed 5-year OS rate is 15.3%, and the median OS time is 15 months for Stage IV CRC with pulmonary metastasis. Surgical management, middle age group (40–59 years), absence of perineural invasion, and isolated pulmonary metastasis at diagnosis may be associated with improved survival. Female gender, tumor status T4, Carcinoembryonic <=5 at diagnosis, and metachronous lung mts were associated with poorer survival outcomes. Despite the study’s limitations of retrospective design with a small sample size, the results can be considered as part of MDT-based decision-making. These findings will require future large multicenter studies.