Background: Sleeve lobectomy (SL) presents an attractive option compared to pneumonectomy (PN) for patients with central or locally advanced non-small cell lung cancer (NSCLC). This study aimed to assess the advantages of SL over PN for NSCLC via a meta-analysis. Methods: We performed a systematic review and cumulative analysis of comparative studies that reported both postoperative and survival outcomes for SL and PN. This was accomplished through a thorough search of electronic databases, including PubMed, EMBASE, and the Cochrane library, from inception to April 2023. Results: A total of 5727 patients (SL: 1945; PN: 3782) from thirty-one studies were analyzed. The meta-analysis focused on perioperative mortality, local recurrence, and overall survival. The SL group exhibited a significantly lower rate of perioperative mortality (OR = 0.43, 95% CI = 0.32–0.60, P < 0.0001). However, no significant difference was observed in local recurrence rates between SL and PN (OR = 1.25; 95% CI, 0.92 to 1.69; P = 0.16). Additionally, the survival rates at 1 year and 5 years in the SL cohort (1-year: 0.14, 95% CI: 0.12 to 0.17, p < 0.0001; 5-year: 2.15, 95% CI: 1.77 to 2.61, p < 0.0001) along with the survival in patients with pN0 or pN1 at 5 years (OR = 0.13, 95% CI 0.04 to 0.22; P = 0.006) were notably superior compared to those undergoing PN. Conclusions: Sleeve lobectomy should be regarded as a viable alternative to pneumonectomy for treating NSCLC.