Abstract: For locally advanced esophageal squamous cell carcinoma (ESCC), neoadjuvant therapy combined with surgery has become the standard treatment schedule. The application of immunotherapy, represented by programmed death‑1 and programmed death‑ligand 1 inhibitors, has injected new vitality into neoadjuvant therapy for ESCC. At present, a large number of clinical trials are being carried out and explored, which brings new challenges to the diagnosis of clinical pathologists. Combined with the latest researches at home and abroad and clinical diagnosis problems, the authors summarize the relevant problems and progress of pathological evaluation before and after neoadjuvant immunotherapy from the perspective of pathology, in order to improve the level of clinical pathological diagnosis and provide reference for further optimizing the comprehensive treat-ment strategy.