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Background: Patients with interstitial lung disease (ILD) have higher incidence of lung cancer. Treatment for this group is challenging, and long term outcome is poor. We investigated the outcome of patients with lung cancer and ILD after surgical resection, along with risk factor of survival and acute exacerbation. Patients with interstitial lung disease(ILD) have higher incidence of lung cancer. Treatment for this group is challenging, and long term outcome is poor. We investigated the outcome of patients with lung cancer and ILD after surgical resection, along with risk factor of survival and acute exacerbation. Method: Between January 2002 and August 2016, total 3413 patients underwent pulmonary resection for lung cancer, among them 74 patients had combined ILD. The demographics, operative and survival data were reviewed. Result: Mean age was 68±7 years-old for 74 ILD patients. 51 (68.9%) patients received video-assisted thoracic surgery (VATS). Lobectomy and sublobar resection were performed to 58 (78.4%) and 15 (20.3%) patients, respectively. 30 (41.5%) patients experienced respiratory complication during early postoperative period. 30-, 90-days mortality and 5-year survival rate were significantly worse than patients without ILD in the same study period (8.1%, 21%, and 21.2% vs. 1.3%, 3.1%, and 73.8%, respectively, p<0.001). Patients with ILD who experienced respiratory complication showed significantly worse 5-year survival than those who has not (18.2% vs. 44.9%, p<0.001). The leading cause of death was cancer related (47.8%), followed by postoperative complications (23.9%). Among 23 patients who received adjuvant therapy, 10 patients died during or shortly after adjuvant therapy. Open thoracotomy (HR 4.02, p¼0.017) was risk factor for respiratory complication. Sublobar resection showed similar survival rate in each stage (stage I, p¼0.825 and stage II-III, p¼0.633) and lower rate of respiratory complication than lobectomy, although statistically not significant (26.7% vs. 43.1%, p¼0.246). Conclusion: Interstitial lung disease increased the risk of pulmonary resection for lung cancer. Thoracotomy was associated with higher rate of respiratory complication. Sublobar resection showed similar survival with lower respiratory complication rate compared to lobectomy. Adjuvant therapy should be considered after careful weighing of risk and benefit.