Abstract: Esophageal cancer, as a highly prevalent malignant tumor of the digestive tract in China, has consistently garnered clinical interest for its treatment efficacy and quality of life of patients. Neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for locally advanced esophageal cancer in many countries. However, up to 29% of patients exhibit a pathological complete response in the resected specimen, which requires reconsideration of the necessity of performing standard procedures for all operable patients after nCRT. The SANO study showed that patients who achieved clinical complete response (cCR) through strict screening via active surveillance (AS) or "watch and wait" strategies had a 2-year overall survival rate of 74%, comparable to the 71% associated with surgical treatment, and 31% of patients successfully avoided esophagectomy at the end of follow-up. Through a multimodal two-stage evaluation (endoscopic deep biopsy and combined application of endoscopic ultrasound and PET-CT), the rate of undetected residual lesions can be reduced to 10%. However, the false negative rate of cCR assessment is 8%-12%, and about one-third of patients diagnosed with cCR actually have residual lesions. Unfortunately, the existing long-term survival data are insufficient. AS should not be used as a routine recommendation at this time, because the precise assessment of high-frequency invasiveness requires screening patients with high compliance, along with a medical team that can perform emergency rescue surgery at any time. The final decision must rely on the multidisciplinary team+shared decision-making working approach for personalized management.