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

Core Tip

Core Tip: Esophageal cancer (EC) ranks among the most prevalent malignant tumors worldwide. Organ preservation (OP) therapy aims to optimize patient quality of life without compromising survival outcomes. Recent advances in endoscopic techniques and immunotherapy have significantly improved the safety and feasibility of OP strategies for EC. However, the widespread implementation of OP remains limited by several challenges. These include discrepancies between clinical complete response and pathological complete response assessments, uncertainties regarding long-term safety, and the absence of standardized patient selection criteria. Future efforts should focus on enhancing the predictive accuracy of treatment response, optimizing active surveillance protocols, strategically integrating immunotherapy into neoadjuvant frameworks, and validating these approaches through rigorously designed, sufficiently powered, multicenter randomized controlled trials.