Neoadjuvant chemoradiation-immunotherapy offers better pathologic complete response rates compared to neoadjuvant chemoimmunotherapy alone in patients with locally advanced esophageal squamous cell carcinoma, but it comes with increased postoperative pulmonary complications without improving long-term survival.

• Pathologic complete response (PCR) for nCRI was 41.1% vs. 19.4% for nCIT (p < 0.001).
• Postoperative pulmonary complications were significantly higher with nCRI (37.1%) compared to nCIT (16.9%, p < 0.001).

Consider the risk of pulmonary complications when discussing neoadjuvant therapy options with patients.