Abstract: Non-small cell lung cancer (NSCLC) is one of the most common and deadly malignant tumors worldwide, with surgical resection being the primary treatment for early-stage NSCLC. Tumor spread through air spaces (STAS) is a novel pattern of tumor dissemination into the air spaces in the lung. Its occurrence after sublobar resection is closely associated with recurrence and distant metastasis, making its consideration a vital factor in surgical strategy selection and prognostic evaluation. Patients with STAS-positive status exhibit significantly higher postoperative recurrence rates than do STAS-negative patients, with molecular mechanisms involving tumor microenvironment remodeling, specific genetic mutations, and epithelial-mesenchymal transition (EMT). Imaging techniques including computed tomography (CT) and positron emission tomography/CT have shown potential for preoperative STAS prediction, although their accuracy and practicality require improvement. This paper reviews the definition, pathological characteristics, and related mechanisms of STAS, with a focus on surgical approach selection for STAS-positive patients and its role in cancer recurrence after sublobar resection of early-stage NSCLC. Future research directions include optimization of preoperative diagnostic methods for STAS, exploration of molecular targeted therapies, and development of imaging-based precision prediction models.