Background: Postoperative acute lung injury (ALI) following lung resection surgery is common and often related to mortality. Aims of this study were to identify the modifiable risk factors of postoperative ALI following lung cancer surgery. Method: We retrospectively analyzed medical records of 323 patients underwent surgery for lung from January 2012 to December 2015. Postoperative ALI was defined as bilateral diffuse pulmonary infiltration on chest radiography, oxygenation failure (PaO2/FiO2 < 300) and absence of sign of left ventricular failure. Result: In study period, 296 lobectomies, 7 bilobectomies, 7 pneumonectomies and 13 segmentectomies or wedge resection were performed. The overall incidence of postoperative ALI was 2.8 % (9/323); 5 patients developed pneumonia with ARDS, and 4 patients developed ALI without clinical infection sign. Logistic regression model showed underlying interstitial lung disease (OR 17.31, 95% CI 1.54-194.66, p=0.021), intraoperative transfusion (OR 21.10, 95% CI 1.62-272.35, p=0.02) and intravascular fluid during operation (ml/kg) (OR 1.05, 95% CI 1.00-1.09, p=0.038) were risk factors of postoperative ALI. Clinical burden of postoperative ALI were increase of intensive care unit admission, mechanical ventilator care, prolonger hospital stay and increased mortality. Conclusion: The clinical impact of postoperative ALI is marked. Significant independent risk factors have been identified in underlying interstitial lung disease, intraoperative transfusion and amount of fluid.