Purpose <p>To preserve the lung function, sublobar resection is considered better than lobectomy in octogenarians with clinical stage IA (c-stage IA) lung cancer. We explored the survival benefits of lobectomy versus sublobar resection in octogenarians undergoing surgery for c-stage IA lung cancer.</p> Methods <p>Between April 2004 and December 2024, 289 of the 2,650 patients who underwent surgery for lung cancer were octogenarians with c-stage IA. We analyzed survival and prognostic factors using propensity score matching to compare lobectomy and sublobar resection.</p> Results <p>The median patient age was 82&#xa0;years (range, 80–91&#xa0;years), and the 90-day mortality rate was 0.7%. Lobectomy, segmentectomy, and wedge resection were performed in 109 (37.7%), 86 (30.0%), and 94 (32.5%) patients, respectively. The 5-year OS rates for lobectomy, segmentectomy, and wedge resection were 61.7%, 74.0%, and 63.0%, respectively (<i>p</i> = 0.382). After propensity score matching, no significant differences in survival were observed between the lobectomy and sublobar resection groups (<i>p</i> = 0.382). There was no difference in the 5-year cumulative incidence of cancer-related deaths between lobectomy (10.5%) and sublobar resection (8.7%) (<i>p</i> = 0.822). <i>A</i> multivariate analysis confirmed that lower performance status was a significant prognostic factor (<i>p</i> &lt; 0.001).</p> Conclusions <p>The surgical procedure type did not affect overall survival in octogenarians with c-stage IA lung cancer, and performance status was a key prognostic factor.</p>