Background: This study aims to compare perioperative and oncologic efficacy of limited resection with lobectomy in clinical stage I non-small cell lung cancer (NSCLC) patients >= 75 years old. Methods: A systemic search of database including PubMed, OVID and Cochrane was carried out to identify the potential relevant studies published. Data extracted were analyzed with Revman 5.1. Results: 5,304 citations were identified by the electronically search. A total of 3,461 patients were included, of whom 1,323 received limited resection and 2,139 received lobectomy. There was higher postoperative complication ratio after lobectomy (32.93% vs. 23.87%, RR =0.71; 95% CI, 0.54-0.93; P=0.01). There were similar total recurrent (18.56%, RR = 1.15; 95% CI, 0.82-1.61; P=0.43), and distant recurrent ratio (16.17%, RR = 0.67; 95% CI, 0.43-1.05; P=0.08) between groups. Lower local-regional recurrent ratio (2.40%, RR = 4.31; 95% CI, 1.98-9.39; P<0.001) was observed after lobectomy. Compared with lobectomy, patients received limited resection showed poorer overall survival (HR = 1.24; 95% CI, 1.07-1.44; P=0.004) and lung cancer specific survival (HR = 1.37; 95% CI, 1.14-1.64; P<0.001). Conclusions: This analysis showed superior lung cancer specific survival, and overall survival after lobectomy over limited resection for clinical stage I NSCLC patients aged = 75 years old. Our results confirmed that lobectomy should be considered in aged patients if tolerable.