Abstract: The management of resectable esophageal squamous cell carcinoma (ESCC) has evolved from surgery alone to individualized care centered on perioperative multimodal therapy. The emergence of neoadjuvant immunotherapy is profoundly reshaping the therapeutic landscape. However, debates persist regarding the comparative efficacy of different treatment modalities e.g., neoadjuvant chemoradiotherapy (nCRT), intensified chemotherapy, and immune-combination therapies, the selection of appropriate patient populations, and postoperative management strategies. This paper provides a comprehensive evaluation of current treatment paradigms through a systematic review of key randomized controlled trials (e.g., CROSS, NEOCRTEC5010, JCOG1109, ESCORT-NEO), large multicenter studies, and recent meta-analyses. The focus is on nCRT, neoadjuvant chemotherapy (nCT), neoadjuvant immune-combination therapy, advancements in surgical strategies (including minimally invasive techniques and controversies surrounding lymphadenectomy), and adjuvant therapy strategies. Furthermore, individualized approaches for early-stage lesions (endoscopic therapy), borderline resectable disease, and elderly/high-risk populations are discussed. The treatment of ESCC has entered a new era of multimodal and personalized therapy. Traditional nCRT and intensified nCT remain cornerstones, while neoadjuvant immunotherapy demonstrates significant potential for improving pathological complete response rates. The adoption of minimally invasive surgery reduces trauma without compromising oncological outcomes. Future directions involve utilizing biomarkers for precise patient selection, optimizing immune-combination strategies, exploring organ preservation, and developing individualized, comprehensive management plans tailored to specific clinical scenarios.