食管癌作为全球范围内常见的消化道恶性肿瘤之一，在中国以鳞状细胞癌为主要病理类型，且多数患者确诊时已处于局部进展期。近年来，免疫检查点抑制剂（ICIs）在晚期及不可切除食管癌中显著改善了患者生存结局，并逐步前移至辅助及新辅助治疗阶段，深刻改变了食管癌整体的治疗格局。随着免疫治疗在食管癌中取得突破性进展并成为综合治疗的核心组成，食管癌围手术期治疗已迈入一个以免疫治疗为基石的全新范式——"后免疫时代"。这一时代不仅标志着治疗策略从单纯验证有效性转向优化整合与个体化应用，更深刻重塑了围手术期管理模式、多学科综合决策流程及对患者长期预后的评估标准。本文旨在综述食管癌免疫治疗的主要临床研究证据，重点总结围手术期免疫治疗的应用现状与临床实施要点，并深入探讨其在多学科协作、手术时机、免疫相关不良反应（irAEs）管理、原发及继发无应答的关注及病理学评估中的关键问题。同时，本文展望了新型免疫靶点、联合治疗策略及生物标志物导向的精准免疫治疗等未来发展方向，以期为围手术期免疫治疗的规范化应用和后续研究提供参考。

Esophageal cancer is one of the most common malignant tumors of the digestive tract worldwide. In China, esophageal squamous cell carcinoma represents the predominant histological subtype, and most patients are diagnosed at a locally advanced stage. In recent years, immune checkpoint inhibitors (ICIs) have significantly improved survival outcomes in patients with advanced or unresectable esophageal cancer and have gradually been incorporated into adjuvant and neoadjuvant settings, profoundly reshaping the overall therapeutic landscape of this disease. With the breakthrough progress of immunotherapy in esophageal cancer and its emergence as a core component of comprehensive treatment, perioperative management of esophageal cancer has entered a new paradigm founded on immunotherapy-the "post-immunotherapy era". This era not only signifies a shift in treatment strategy from merely validating efficacy to optimizing integration and individualized application, but also profoundly reshapes perioperative management models, multidisciplinary team (MDT) decision-making processes, and long-term prognostic assessment standards for patients. This review aims to summarize the major clinical evidence for immunotherapy in esophageal cancer, focusing on the current status and practical considerations of perioperative immunotherapy. It delves into key issues such as multidisciplinary collaboration, surgical timing, management of immune-related adverse events (irAEs), attention to primary and acquired non-response, and pathological response assessment. Furthermore, this article explores future directions, including novel immune targets, combined treatment strategies, and biomarker-guided precision immunotherapy, aiming to provide a comprehensive reference for the standardized application and future research of perioperative immunotherapy.