Introduction: Whenever feasible, sleeve lobectomy is recommended to avoid pneumonectomy for lung cancer, but these guidelines are based on limited retrospective series. The aim of our study was to compare outcomes following sleeve lobectomy and pneumonectomy using data from a national database. Methods: From 2005 to 2014, 941 sleeve lobectomy and 5318 pneumonectomy patients were recorded in the French database Epithor. Propensity score was generated with 15 pretreatment variables and used to create balanced groups with matching (794 matches) and inverse probability of treatment weighting (standardized difference was 0 for matching, and 0.0025 after weighting). Odds ratio (OR) of postoperative complications and mortality and hazard ratio (HR) for overall survival and disease-free survival were calculated using propensity adjustment techniques and a sensitivity analysis. Results: Postoperative mortality after sleeve resection was similar to that after pneumonectomy (matching OR, 1.24; P = .4; weighting OR, 0.77; P = .4) despite significantly lower odds of pulmonary complications with pneumonectomy (matching OR, 0.4; P