Background <p>Patients undergoing esophageal cancer surgery often experience multidimensional preoperative fear. Quantitative assessments alone may not fully capture how these fears are understood and experienced.</p> Aim <p>To examine the network structure of preoperative fear and explore patients’ experiences through integrated quantitative and qualitative findings.</p> Methods <p>A convergent mixed-methods design was used. Quantitative data were collected from 584 patients using the Surgical Fear Questionnaire and analyzed with network analysis. Qualitative data were obtained through semi-structured interviews with 18 patients and analyzed using codebook thematic analysis. Findings were integrated through a joint display.</p> Results <p>FEAR3 (fear of pain) had the highest expected influence and occupied the most central position in the network. The strongest connection was between FEAR3 and FEAR4 (fear of side effects). FEAR5 (fear of health deterioration) showed the highest mean score but lower expected influence. Four themes were identified: fears of deterioration, incomplete recovery, and burden; anticipating surgical pain; fear arising from limited understanding and fragmented information; and loss of bodily control during surgery and anesthesia. Integration showed that fear of pain was both statistically central and experientially salient, while qualitative findings expanded understanding of concerns related to information uncertainty, dignity, bodily control, and vulnerability.</p> Conclusion <p>Preoperative fear in patients with esophageal cancer involves interconnected concerns about pain, side effects, health deterioration, recovery, information uncertainty, and loss of control. Pain-related fear may be an important focus for preoperative nursing assessment and education. Patient-centered preoperative care should address pain expectations, recovery concerns, information needs, and issues of dignity and control.</p>