Organ preservation in esophageal cancer treatment, is it time now?

As esophageal cancer (EC) is a prevalent malignancy of the digestive tract, with esophageal squamous cell carcinoma being its predominant pathological subtype, accounting for nearly 90% of all cases. Current treatment modalities for EC include surgery, chemotherapy, and radiotherapy; however, single-modality therapies are associated with inherent limitations. Advances in endoscopic techniques and the integration of immunotherapy have enhanced the feasibility and safety of organ-preserving strategies for EC. These approaches enable patients to achieve prolonged survival and an improved quality of life. Nevertheless, the criteria for selecting patients suitable for organ preservation require further refinement through active surveillance. The optimal timing for surgical intervention in patients with tumor progression or metastasis remains controversial; however, the "watch and wait" strategy may represent a viable option for selected individuals.