Background and objective National Comprehensive Cancer Network (NCCN) guidelines recom-mend video-assisted thoracoscopic surgery (VATS) anatomical lobectomy as the ifrst choice for the treatment of resectable lung cancer. However, sublobar resection offers signiifcantly better functional preservation compared with lobectomy for stage I lung cancer. At present, the inferiority of sublobar resection to lobectomy is still uncertain. Herein, we compared the prognoses of these two types of surgical treatment for stage I lung adenocarcinoma. Methods Retrospective research was conducted on 258 patients with stage I lung adenocarcinomas who underwent VATS lobectomy and sublobar resection at the First Affliated Hospital of Guangzhou Medical University between January 2009 and December 2011. VATS lobectomy was performed on 222 patients, and VATS sublobe resection was performed on 36 patients. Propensity score matching analyses were conducted on the two groups. Results A total of 70 patients were matched in the two groups. No signiifcant difference was observed between the lobectomy and sublobar resection groups atfer matching (P=0.137). hTe disease-free survival (DFS) of the two groups were 49.3 and 42.7 months, and their overall survival (OS) were 50.3 and 49.0 months (P=0.122). Further, stratiifed analysis showed no signiifcant differences in DFS and OS between the two groups with stage Ia lung adenocarcinoma. Nev-ertheless, the DFS and OS of the two groups signiifcantly differed in matched patients with stage Ib lung adenocarcinomas. Conclusion Sublobar resection could achieve a similar prognosis to VATS lobectomy for stage Ia lung adenocarcinoma. Lo-bectomy should still be the ifrst choice for the treatment of stage Ib lung adenocarcinoma.