**2. Patient selection**

Tumor staging is essential for planning surgical treatment, and surgery should not be performed for patients without a chance of cure, such as those with distant metastases, or in those unable to survive the physiologic insult of the operation. The main objective of surgery must be to achieve a R0 resection. Nowadays, neoadjuvant chemoradiation plays a key role because it downstages the tumor and allows an adequate micro and macroscopic tumoral resection. From a surgical perspective, the drawback is that it may further complicate the procedure by distorting the peri-esophageal microanatomy and by causing a significant postradiation fibrosis. Tissue plane may be unclear and surgery will not be easy in this situation.

The difficult dissection as a result of neoadjuvant therapy and surgeons' fear to use a minimally invasive approach in advanced tumors, especially during their learning curve, cause an important discussion about MIE effectiveness in these situations. In a multicenter, open-label, randomized controlled trial published in 2012 by Biere et al. [15] that compares open surgery with MIE in advanced tumors, both with a similar number of patients, did not show significant differences between both in terms of margins resection. Thus, the minimally invasive approach would not be a contraindication in advanced stages. However, a previous history of abdominal or thoracic surgeries due to a significant underlying adhesion process could represent a real hindrance for minimally invasive technique.
