Efficacy of surgical treatment of cancer is one of your research interests. In the outcome studies, how effective is the surgical treatment for esophageal cancer? Dr. Anton Titov, MD. How can it be improved further? Although there have been many developments in chemotherapy and chemoradiation therapy, I think that at least most of the surgeons and most of the doctors agree that surgery is still the fundamental part of curative treatment esophageal cancer. Of course, the surgery must be safe for the patient. Dr. Jari Rasanen, MD. And one of the things that we have been doing in our institution to make it safe for the patient is that we have used minimally invasive esophageal surgery since 2009. Dr. Jari Rasanen, MD. And by that, we have reduced the number of complications, especially pulmonary complications. Dr. Jari Rasanen, MD. And this makes the surgery safe for the patient. On the other hand, the results in good surgical centers should show that you should have at least more than 50% five-year survival after surgery if you are a specialized center. Professor Rasanen, what is a minimally invasive esophageal cancer surgery? Minimally invasive esophagectomy. Dr. Anton Titov, MD. How does it differ from the classical approach? Dr. Anton Titov, MD. How to decide if a patient merits a minimally invasive surgery versus a classical approach in esophageal cancer? Minimally invasive surgery means in esophageal surgery the same thing as in all surgery. You are replacing the big incision laparotomy by laparoscopy in the abdomen. Then in the chest, you are replacing a large thoracotomy by thoracoscopy. So, you make only small keyholes, and you can do the same thing as in open surgery through those holes. So basically, most of the esophageal cancer cases are suitable for minimally invasive surgery. It depends on the surgeon's experience, whether he can perform the minimally invasive procedure or if he is doing the open esophagectomy better. So this is very important to note that the minimally invasive approaches in the esophageal surgery, in lung cancer surgery, are very operator-dependent. Dr. Jari Rasanen, MD. And perhaps for some patients, it's better to do the surgery with a classical approach, if the surgeon is not very experienced and skillful with minimally invasive surgery. Exactly, it very much depends on the experience of the surgeon. I completely agree that if the surgeon doesn't have that much experience in minimally invasive surgery, it is a better option to do open surgery and by that avoid complications that can occur during the minimally invasive surgery because you don't have enough experience. So basically, I still think that open surgery is a viable option. If the surgeon feels that he is more comfortable with open surgery than with minimally invasive surgery. Dr. Anton Titov, MD. What do long-term results look like when you compare the minimally invasive approaches for esophageal cancer and the more classical approach for esophageal cancer? Are the local recurrence rates the same? Do they differ? Dr. Anton Titov, MD. What about the long-term quality of life of patients? Short term outcome, of course, is much better with minimally invasive esophageal surgery, we know that. But what about the long term outcomes? [surgery for esophageal cancer] Well, the overall survival seems to be pretty much the same after open and minimally invasive surgery. Some studies show that the overall survival can be a little bit better after minimally invasive surgery than after open surgery both in esophageal and lung surgery. But it is very difficult to say whether it depends on the patient selection or there are any other confounding factors that can affect the surgery outcomes. Therefore, I think that the main thing is that the quality of life, especially in the short term, is better for the patient after minimally invasive surgery. Some studies show that the long-term quality of life is also better after minimally invasive surgery. The patients are suffering significantly less from pain, they have to stay shorter time in the hospital. Dr. Jari Rasanen, MD. And they also have other cardiovascular complications that are less frequent after the minimally invasive surgery. So the patients are doing a lot better after minimally invasive surgery, both in the short and long term.