This study compares long-term overall survival (OS) of patients with early-stage non–small cell lung cancer (ES NSCLC) after surgery versus stereotactic body radiotherapy (SBRT), considering the extent of regional lymph node examination (LNE). Analyzing data from the National Cancer Database, the study finds that surgery, especially lobectomy with extensive LNE, is associated with significantly better long-term survival compared to SBRT. The findings suggest that curative-intent surgery coupled with appropriate regional LNE offers the best long-term OS for patients with ES NSCLC, although SBRT may be a reasonable alternative in certain situations, particularly for older patients or those unable to tolerate extensive surgery.