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.