This review discusses the role of perioperative immunotherapy in the treatment of esophageal squamous cell carcinoma (ESCC). ESCC is the most common histological subtype of esophageal cancer, accounting for 85% of all cases worldwide. Traditional treatments include chemotherapy, radiotherapy, and surgery, but these have limited success. Immune checkpoint blockade (ICB) therapy using anti-PD-1/PD-L1 antibodies has shown significant benefits in ESCC treatment. ICB therapy has been added to standard first-line treatment regimens for ESCC. However, preoperative immunotherapy is not yet approved. This review summarizes the ICB antibodies used in clinical immunotherapy for ESCC and discusses advances in immunotherapy combined with chemotherapy and radiotherapy in the perioperative treatment of ESCC. The goal is to provide guidance for the clinical management of ESCC patients throughout their treatment. The review highlights that the combination of immunotherapy and chemotherapy offers a potential perioperative option for patients with resectable ESCC. Neoadjuvant immunotherapy combined with chemotherapy results in encouraging major pathologic response rates without introducing new adverse reactions in patients with operable ESCC. The review also discusses the progress of neoadjuvant immunotherapy combined with chemotherapy in the treatment of resectable ESCC. It highlights the findings of several clinical trials, including the CROSS study, which demonstrated the benefits of neoadjuvant chemoradiotherapy in ESCC. The study also found that neoadjuvant immunotherapy combined with chemotherapy can achieve high rates of pathological complete response and major pathological response. The review also discusses the progress of immunotherapy combined with chemotherapy in the adjuvant setting of ESCC. It highlights the findings of the CheckMate 577 study, which demonstrated the benefits of adjuvant nivolumab in ESCC. The study also found that adjuvant nivolumab provided survival benefits regardless of histological type and pathological features of lymph nodes. The review concludes that immunotherapy combined with chemotherapy is a promising regimen for the treatment of ESCC. The review also discusses the challenges and future directions of perioperative immunotherapy in ESCC. It highlights the need to identify predictive biomarkers and target patients for immunotherapy. The review also discusses the mechanisms of immune checkpoint blockade and the factors that influence the response to PD-1/PD-L1 blockade therapy. The review concludes that immunotherapy is a promising treatment for ESCC, but further research is needed to improve its efficacy and safety. The review also discusses the importance of multi-disciplinary treatment models and the need for further research to improve the outcomes of ESCC patients.This review discusses the role of perioperative immunotherapy in the treatment of esophageal squamous cell carcinoma (ESCC). ESCC is the most common histological subtype of esophageal cancer, accounting for 85% of all cases worldwide. Traditional treatments include chemotherapy, radiotherapy, and surgery, but these have limited success. Immune checkpoint blockade (ICB) therapy using anti-PD-1/PD-L1 antibodies has shown significant benefits in ESCC treatment. ICB therapy has been added to standard first-line treatment regimens for ESCC. However, preoperative immunotherapy is not yet approved. This review summarizes the ICB antibodies used in clinical immunotherapy for ESCC and discusses advances in immunotherapy combined with chemotherapy and radiotherapy in the perioperative treatment of ESCC. The goal is to provide guidance for the clinical management of ESCC patients throughout their treatment. The review highlights that the combination of immunotherapy and chemotherapy offers a potential perioperative option for patients with resectable ESCC. Neoadjuvant immunotherapy combined with chemotherapy results in encouraging major pathologic response rates without introducing new adverse reactions in patients with operable ESCC. The review also discusses the progress of neoadjuvant immunotherapy combined with chemotherapy in the treatment of resectable ESCC. It highlights the findings of several clinical trials, including the CROSS study, which demonstrated the benefits of neoadjuvant chemoradiotherapy in ESCC. The study also found that neoadjuvant immunotherapy combined with chemotherapy can achieve high rates of pathological complete response and major pathological response. The review also discusses the progress of immunotherapy combined with chemotherapy in the adjuvant setting of ESCC. It highlights the findings of the CheckMate 577 study, which demonstrated the benefits of adjuvant nivolumab in ESCC. The study also found that adjuvant nivolumab provided survival benefits regardless of histological type and pathological features of lymph nodes. The review concludes that immunotherapy combined with chemotherapy is a promising regimen for the treatment of ESCC. The review also discusses the challenges and future directions of perioperative immunotherapy in ESCC. It highlights the need to identify predictive biomarkers and target patients for immunotherapy. The review also discusses the mechanisms of immune checkpoint blockade and the factors that influence the response to PD-1/PD-L1 blockade therapy. The review concludes that immunotherapy is a promising treatment for ESCC, but further research is needed to improve its efficacy and safety. The review also discusses the importance of multi-disciplinary treatment models and the need for further research to improve the outcomes of ESCC patients.