- The main title card shows as 'John Rambo' and now appears across the screen.
- At the beginning, Rambo traps the second snake followed by a new scene where the deckhands played with it on the boat.
- While working on the metal for the new propeller, Sara visits him in an another attempt to persuade him to change his mind to take them upriver.
- While upriver, Rambo and Sara's moments are longer, as both get to know one another better.
- The bad guy who laid dying on Rambo's boat only has a bullet shot on the head. In the theatrical cut, there were multiple gunshots all over the body.
- While passing the armor boat on the way back from Burma, Rambo takes out his knife in the hidden compartment.
- After driving the armor boat to the shore, there is an additional scene where he burns it along with his knife.
- During the village massacre by the regime, there were alternate shots of villages in cages and the hazing of the young boys.
- When the pastor seeks Rambo's help, he was actually instructed to pray while Rambo forges his blade. Later, the pastor watches the mercenaries head downriver.
- While escaping the military village, Rambo notices lacerations on Sara's feet and bandages them.