Objective This study aims to compare the clinical efficacy and complications associated with microwave ablation （MWA） and sublobectomyfor treating stage ⅠA non?small cell lung cancer （NSCLC）. Methods Data from stage ⅠA1?ⅠA3 NSCLC patients treated at Yunnan Cancer Hospital between January 2021 and December 2022 were retrospectively collected. A total of 82 patients who underwent MWA and 82 patients who received sublobectomy were selected through propensity score matching. Periprocedural conditions， short?term efficacy， and complications were compared between the two groups. Progression?free survival （PFS） and Disease?free survival （DFS） were monitored and evaluated. The Kaplan?Meier method was employed to construct survival curves， and logistic regression was utilized to analyze the factors influencing complications. Results The MWA group exhibited shorter procedure times， less intraprocedural blood loss， less postprocedure pain， shorter hospitalization durations， and lower hospitalization costs compared to the sublobectomy group （P < 0.001）. All patients successfully underwent the procedures， with a complete ablation rate of 97.6% and a local control rate of 87.8%in the MWA group. The median follow?up duration was 26.5 months. Survival curve analysis indicated no statistically significant differences in PFS and DFS between the two groups. The primary complications observed were pneumothorax （24.4%， 20/82） and moderate to severe pain （11.0%， 9/82） in the MWA group， while the sublobectomy group experienced moderate to severe pain （41.5%， 34/82） and pulmonary infection （12.2%， 10/82）. Single?factor analysis demonstrated six variables influenced the occurrence of MWA pneumothorax. Multi?factor logistic regression revealed that the shortest distance from the tumor to the pleura （P = 0.021，OR = 15.341，95%CI： 1.699 ~ 24.367） and the number of punctures through the pleura （P = 0.024，OR = 0.068， 95%CI： 0.001 ~ 0.612） were identified as independent risk factors for pneumothorax. Conclusion MWA demonstrates good efficacy for treating stage ⅠA NSCLC due to minimal trauma， low cost， rapid recovery， few and mild complications. Additionally， MWA and sublobectomy exhibit comparable PFS and DFS， making MWA a safe and effective treatment method. Therefore， MWA is worthy of promotion in clinical practice.