In patients with locally advanced esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy (ncit) significantly improves three-year overall survival compared to standard chemoradiotherapy (ncrt).

• Three-year overall survival rate was 79.7% for ncit versus 68.2% for ncrt (HR 0.51, p = 0.023).
• ncit also showed lower rates of overall recurrence (15.8% vs 28.8%, p = 0.033) and distant metastases (6.6% vs 17.0%, p = 0.006) within two years postoperatively.

Surgeons may consider ncit as a preferable neoadjuvant strategy for enhancing long-term outcomes in eligible patients.