Abstract: In the era of multidisciplinary treatment of esophageal cancer, especially the development of immunotherapy, the aim of organ‑sparing treatment is to improve quality of life without reducing survival. After neoadjuvant therapy, the common efficacy evaluation methods are endoscopic biopsy and imaging examination, which may help patients with complete response obtaining organ‑sparing treatment. Liquid biopsy technology represented by circulating tumor cells is a novel evaluation method, which will be used in multimodality evaluation to guide clinical decision making in the future. For organ‑sparing treatment, it should consider the period of surgical window and optimization of combined treatment (chemotherapy regimens and radiation doses, etc.) to achieve a higher pathologic complete response rate. In the era of immunotherapy, it is necessary to explore effectively predictive biomarkers to identify patients who are suitable for organ‑sparing treatment, and individualize the best combination therapy for different patients. At the same time, strengthening the intensity of consolidation therapy is also an important role for immunotherapy in organ‑sparing treatment. Active surveillance is required to detect recurrence and implement salvage therapy for patients who received organ‑sparing treatment. It is expected that the organ‑sparing treatment of esophageal cancer could be developed under the new era of immunotherapy.