Objective:

To clarify the comparative efficacy of lobectomy and sublobectomy in Stage I non-small cell lung cancer (NSCLC) regarding overall survival (OS) and disease-free survival (DFS), while evaluating the methodological quality of existing meta-analyses.

Key Findings:

• Eighteen reviews included: 9 high quality, 4 moderate, 5 critically low.
• Pooled hazard ratios (HRs) for overall survival (OS) showed substantial heterogeneity, indicating variability in outcomes across studies.
• For Stage I NSCLC, HR for OS was 1.09 (95% CI 1.02–1.16; I² = 71.6%), suggesting a slight increase in risk associated with sublobar resection.
• For disease-free survival (DFS), HRs were 1.13 (95% CI 1.04–1.23; I² = 9.4%) for Stage I, indicating a statistically significant difference.
• Evidence certainty was predominantly low or very low.

Interpretation:

Sublobar resection was associated with a small but statistically significant higher hazard for OS and DFS in the broader Stage I population, while Stage IA OS did not differ significantly, suggesting careful consideration in surgical decision-making.

Limitations:

• Substantial heterogeneity in OS estimates limits the reliability of conclusions.
• Small-study effects and overlap among primary evidence may skew results.
• Predominantly low or very low certainty of evidence raises concerns about the robustness of findings.

Conclusion:

This umbrella review clarifies the quality, bias, overlap, and applicability of existing meta-analytic evidence, providing a foundation for future research and clinical decision-making rather than replacing recent randomized trials.