Abstract: Esophageal cancer, as a highly prevalent malignant tumor of the digestive tract in China, has always been a focus of clinical attention on its treatment efficacy and patient quality of life (QoL). Neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for locally advanced esophageal cancer in many countries. However, up to one-third (29%) of patients have 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 using active surveillance (AS) or "watch and wait" strategies had a 2-year overall survival rate of 74%, which is not inferior to the 71% of surgical treatment, and 31% of patients successfully avoided esophagectomy at the end of follow-up. Through multimodal two-stage evaluation (endoscopic deep biopsy, combined application of endoscopic ultrasound and PET-CT), the missed diagnosis rate of 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. The existing long-term survival data is not sufficient, and 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, and a medical team that can perform emergency rescue surgery at any time is also needed. The final decision must rely on the Multidisciplinary team(MDT)+shared decision-making(SDM)working mode for personalized processing.