Abstract Background Surgery resection would improve idiopathic pulmonary fibrosis (IPF) patients with early-stage lung cancer (LC). However, most associated studies were published from surgeons. Interstitial lung disease (ILD) physicians involved in perioperative management would be helpful for improving patients with idiopathic pulmonary fibrosis combined with lung cancer (IPF-LC). To enhance the understanding of the clinical characteristics presented by patients with IPF-LC who have undergone surgical resection, and to explore the factors linked to unfavorable prognosis, our ILD physicians conducted this study. Methods We retrospectively examined clinical records of IPF-LC patients at Peking Union Medical College Hospital from January 2014 to December 2023.Data related to clinical manifestations and treatment methods were collected. Patients underwent routine follow-up through clinical assessments and telephone consultations. The demographic, clinical, and laboratory features of 12 surviving patients and 8 deceased patients were comparatively analysed. Results There were 30 males and 2 females, aged from 49 years to 82 years. Twenty-eight patients had a history of smoking. Twenty-five patients had at least one comorbidity and emphysema was the most common. IPF was diagnosed before LC in 8 patients but none of them were prescribed with anti-fibrotic medications. Twenty-four patients were simultaneously diagnosed with LC and IPF, and 7 of them were prescribed anti-fibrotic medications. After surgery, 27 patients were pathologically diagnosed with non-small cell lung cancer and 26 patients were classified as stage I or II lung cancer. During follow-up, 8 patients died, 12 patients lost follow-up and 12 patients survived. Among the 8 deceased patients, 5 patients died from acute exacerbation of IPF, one died from cancer progression and 2 died from surgical complications. The serum Cyfra211 level was higher and the lung cancer stage was more advanced in the non-survival group than in the survival group. Conclusion Most of our IPF-LC patients were elderly males with a history of smoking and had at least one comorbidity. Most of them were diagnosed with IPF and LC simultaneously. However, only one fifth were prescribed with pirfenidone or nintedanib. Acute exacerbation of IPF was the main cause of death. Similar to the LC patients, higher serum Cyfra211 levels and more advanced lung cancer stages were associated with a poor prognosis for our enrolled IPF-LC patients. Clinical trial number Not applicable.