Objective To compare the survival outcomes in patients with epidermal growth factor receptor (EGFR)-mutated stageⅠ invasive lung adenocarcinoma who underwent lobectomy, sublobar resection, and sublobar resection plus postoperative targeted therapy, and to evaluate whether the combined strategy yield outcomes similar to lobectomy in a real-world setting. MethodsThis retrospective cohort study enrolled consecutive patients who underwent video-assisted thoracoscopic radical resection at West China Hospital, Sichuan University, between November 2017 and April 2025. All patients had postoperative pathologic stageⅠ invasive lung adenocarcinoma according to the 8th edition of the TNM stage, and confirmed EGFR mutations. Patients were categorized into three groups: a lobectomy alone group (lobectomy group), a sublobar resection alone group (sublobar resection group), and a sublobar resection plus postoperative targeted therapy group (combined group). Inverse probability of treatment weighting (IPTW) was applied to balance the baseline characteristics. Overall survival (OS) and recurrence-free survival (RFS), defined as time to first recurrence with death treated as censoring, were compared. ResultsA total of 450 patients was enrolled with 157 in the lobectomy group, 240 in the sublobar resection group, and 53 in the combined group. Among patients who did not receive any adjuvant therapy, OS was similar between the sublobar group and the lobectomy group, whereas sublobar resection had significantly poor RFS. In comparisons between the lobectomy group and the combined group, neither OS nor RFS differed significantly before or after IPTW adjustment. ConclusionsAmong patients with EGFR-mutated stageⅠ lung adenocarcinoma, sublobar resection is associated with poor RFS when compared with lobectomy. The combined strategy shows no statistically significant survival difference versus lobectomy. Prospective studies with rigorous design are warranted to further validate the above findings.