Lymph node metastasis in oesophageal cancer—what we (do not) know?

Although many aspects of the treatment of oesophageal cancer remain controversial, one of them is beyond doubt: prognosis in this disease is still poor, with overall 5-year survival slightly over 10% (1). One of the most important issues determining prognosis is metastatic spread in the lymphatic system. The mechanism of this spread is poorly understood, as is the role of lymphadenectomy. Whilst there are ongoing discussions on the impact of lymph node dissection on survival, it is generally agreed that lymphadenectomy enables accurate staging and, therefore, is important for prognostic purposes. However, high quality scientific data regarding many factors related to this issue are scarce.