Abstract: In recent years, immunotherapy has expanded from adjuvant therapy to neoadju-vant therapy, providing new therapeutic strategies for patients with locally advanced resectable esophageal squamous cell carcinoma. The world′s first study on neoadjuvant immunotherapy with a single immunotherapy agent for locally advanced esophageal squamous cell carcinoma, the NATION-1907, revealed that neoadjuvant immunotherapy can significantly extend patient survival and reduce the risk of postoperative recurrence and distant metastasis. Compared with traditional neoadjuvant chemotherapy and chemoradiotherapy, immunotherapy enhances the cytotoxic effect on tumor cells by activating the systemic immune system and shows better safety and feasibility, offering new treatment options for patients who cannot tolerate chemotherapy or chemoradio-therapy. However, whether the pathological complete response rate can replace overall survival as the primary efficacy indicator still requires further investigation. More prospective studies are needed in the future to compare the efficacy of different immunotherapy regimens, particularly personalized treatments guided by biomarkers. Overall, neoadjuvant immunotherapy offers new hope for patients with locally advanced esophageal squamous cell carcinoma, but there are unexplored areas worth investigating. Combined with practical experience, the authors summarize the latest research results at home and abroad, and elaborate on the efficacy, outcome indicator selection, and precise treatment of neoadju-vant therapy for locally advanced esophageal squamous cell carcinoma, aiming to provide reference for the clinical diagnosis and treatment of this disease.