Sleeve lobectomy was initially conceived as an alternative to pneumonectomy for patients with low-grade, centrally located lesions and limited cardiopulmonary reserve. Over the last several decades, advances in patient selection criteria and surgical techniques have allowed sleeve lobectomy to evolve from a compromise to pneumonectomy to first line intervention for centrally located lesions of all grades. Although more challenging than pneumonectomy, long-term outcomes and cost-effective measures favor sleeve lobectomy. The use of sleeve lobectomy has been expanded for locally advanced disease, and results remain superior to alternative procedures. Current literature has also shown evidence supporting the use of neoadjuvant treatment and minimally invasive techniques. It is likely that future results will continue to improve making sleeve lobectomy an even more attractive treatment option for qualifying patients.