Postoperative Morbidity and Long-Term Survival After Esophagectomy for Cancer Is Not Influenced by Gender: A Propensity-Score Matched Analysis

Background The incidence of esophageal cancer is higher in men than in women, likely due to differences in exposure to risk factors, hormonal influences, and genomic alterations. Consequently, esophageal cancer in women may be associated with distinct postoperative morbidity and long-term outcomes. However, the impact of gender on early postoperative complications and long-term survival remains poorly understood. Methods All consecutive patients (486 patients) who underwent esophagectomy with curative intent for clinical stage I–IVa esophageal cancer in our institution between January 2018 and December 2023 were included and stratified by gender (87 women and 399 men). Propensity-score matching with a maximum calliper of 0.05, using the optimal matching method, was applied to balance covariates, including age, ECOG status, diabetes, neoadjuvant therapy, clinical stage, and tumor location, between the two groups. The primary endpoints were early postoperative morbidity, overall survival and recurrence-free survival. Results Before matching, women had higher rates of previous malignancy (26% vs. 16%;p = 0.022), mid-esophageal tumors (30% vs. 9.5%;p < 0.001), squamous cell carcinoma (45% vs. 17%;p < 0.001), and lower-stage tumors (38% vs. 29%;p = 0.007). After matching (84 per group), demographics and treatment strategies were comparable. No significant differences were found in anastomotic leakage (19% vs. 13%;p = 0.29), pneumonia (15% vs. 18%;p = 0.68), grade IV complications (20% vs. 15%;p = 0.65), or 90-day mortality (5% vs. 7%;p = 0.51). Three-year overall survival (67% [95%CI: 57%–78%] vs. 59% [95%CI: 49%–71%];p = 0.30) was comparable, with a trend towards a better recurrence-free survival (67% [95%CI: 57%–78%] vs. 55% [95%CI: 45%–68%];p = 0.070; Fig. 1) among women. Conclusion In our population of esophagectomy patients, tumors in women exhibited distinct characteristics compared to those in men. However, when matched, women underwent similar treatment strategies and experienced comparable postoperative morbidity and long-term survival, with a trend towards a better recurrence-free survival. The current results indicate no clear evidence of gender disparity in the treatment of esophageal cancer. Nevertheless, differences in tumor biology may exist, explaining the difference in recurrence-free survival.