Background <p>Esophageal squamous cell carcinoma (ESCC) and hepatic cirrhosis (HC) share major risk factors, including alcohol consumption and smoking. Consequently, patients with HC exhibit an elevated incidence of ESCC. Although HC is widely recognized to contribute to poor prognosis following esophagectomy for ESCC, the underlying mechanisms remain poorly understood. This study aimed to investigate the association between hepatic fibrosis evaluated using the fibrosis-4 (FIB-4) index and postoperative outcomes among patients with ESCC undergoing esophagectomy.</p> Methods <p>We retrospectively analyzed 461 patients with ESCC who underwent minimally invasive esophagectomy at Kobe University Hospital. Hepatic fibrosis was evaluated using the FIB-4 index, which estimates liver fibrosis based on routine blood test parameters. Patients were stratified into two groups: fibrosis-positive (FIB-4 &gt; 2.67) and fibrosis-negative (FIB-4 ≤ 2.67).</p> Results <p>Among patients with cT1 tumors, overall survival (OS) did not differ significantly between the two groups. However, among those with ≥cT2 tumors, the fibrosis-positive group showed significantly worse OS than the fibrosis-negative group (<i>P</i> = 0.0148). Additionally, the fibrosis-positive group had a significantly higher incidence of poor response to preoperative chemotherapy (<i>P</i> = 0.0075). Postoperative serum albumin levels were markedly lower at 3, 6, and 12 months in the fibrosis-positive group (<i>P</i> = 0.015, 0.043, and 0.0066, respectively). While albumin levels recovered to baseline in the fibrosis-negative group within 12 months, no such recovery was observed in the fibrosis-positive group.</p> Conclusions <p>Preoperative hepatic fibrosis is associated with poor response to preoperative chemotherapy and prolonged postoperative malnutrition, contributing to poorer long-term survival outcomes among patients with ESCC undergoing minimally invasive esophagectomy.</p>