Preoperative nutritional risk influences treatment tolerance and survival in resectable esophageal squamous cell carcinoma (ESCC).

• Higher nutritional risk correlates with decreased surgical completion rates: 97.1% for low risk vs. 76.7% for high risk (p < 0.001).
• High-risk patients face almost double the severe postoperative complications (38.2% vs. 18.0%; p < 0.001) and poorer overall survival outcomes (hazard ratio, 2.03; p < 0.001).

Identifying and monitoring nutritional status can guide surgical decision-making and improve patient outcomes, especially regarding adjuvant immunotherapy’s survival benefits in high-risk patients.

• Adjuvant immunotherapy increased 3-year survival for high-risk patients from 41.7% to 65.8% (p = 0.043).