Using a large cohort, multicenter database, and propensity score-matched analysis, researchers evaluated the oncological outcomes of complex segmentectomy and wedge resection for clinical stage 0-IA lung cancer. Between 2010 and 2018, they reviewed data from 506 patients with clinical stage 0-IA lung cancer with a solid component size of less than or equal to 2.0 cm who underwent surgical resection at 3 different institutions. All patients and their propensity score-matched couples had their surgical results following complex segmentectomy (n=222), and “location-adjusted” wedge resection (n=284) was assessed. In every cohort, the complicated segmentectomy group had a better prognosis than the wedge resection group (5-year cancer-specific survival rate, 97.4% vs. 93.7%; P=.065; 5-year recurrence-free interval [RFI] rates, 96.9% vs. 86.1%; P=.0005). Sub Analyses of pure solid tumors revealed the same pattern. In 179 propensity score-matched pairs, patients with complex segmentectomy had a better prognosis than wedge resection (5-year cancer-specific survival rates, 96.8% vs. 92.9%; 5-year RFI rates 96.3% vs. 87.5%). In addition, complex segmentectomy was found to have a lower risk of lung cancer recurrence than wedge resection in a multivariable Cox regression analysis for RFI (hazard ratio, 0.32; 95% confidence range, 0.12-0.73; P=.0061). When compared to wedge resection, complex segmentectomy could yield better oncological outcomes.