关键词: 免疫治疗, 食管癌, 食管鳞状细胞癌, 围手术期, 外科, 多学科协作

Abstract: Esophageal squamous cell carcinoma dominates esophageal cancer cases in China,with a high proportion of patients diagnosed at locally advanced stages.Conventional neoadjuvant chemotherapy or chemoradiotherapy combined with surgery yields limited efficacy,and the 5-year overall survival rate remains merely 30%-40%.Perioperative immunotherapy centered on PD-1/PD-L1 inhibitors has remarkably broken through therapeutic bottlenecks and evolved into a potential therapeutic strategies for locally advanced esophageal cancer.Phase Ⅲ trials including CheckMate 816 and ESCORT-NEO have validated that neoadjuvant immunotherapy combined with chemotherapy markedly raises the pathological complete response (pCR) rate by 14%-24% compared with conventional chemotherapy,significantly increases the R0 resection rate and improves event-free survival;this regimen has been granted category Ⅰ,1A recommendation as m explanatory in clinical guidelines.Neoadjuvant immunotherapy plus chemoradiotherapy further elevates the pCR rate to 55%-60% for high-risk patients yet carries a higher risk of adverse events.Postoperative adjuvant immunotherapy substantially prolongs disease-free survival among patients failing to achieve pCR after neoadjuvant treatment and serves as a vital consolidation strategy.Radical surgical resection constitutes the cornerstone of perioperative immunotherapy,undertaking core functions including lesion eradication,pathological evaluation and synergizing anti-tumor immune responses.The standardized workflow covers MDT assessment,neoadjuvant therapy,surgery scheduled 4-6 weeks after the last immunotherapy dose,risk-stratified postoperative adjuvant immunotherapy and long-term surveillance.Current challenges involve escalated surgical difficulty,immune-related adverse events,insufficient predictive biomarkers and immune resistance.Future research will focus on novel combinatorial immunotherapies,biomarker-guided precision treatment and standardized multidisciplinary management to further improve long-term survival of patients with locally advanced esophageal cancer.

Key words: immunotherapy, esophageal cancer, esophageal squamous cell carcinoma, perioperative period, surgery, multidisciplinary team