Recently we have established radio-guided method to detect sentinel nodes (SNs) in esophageal cancer. In esophageal cancer, SNs are multiple and widely spread from cervical to abdominal areas. In more than 80% of the cases, at least one SN is located in the 2nd or 3rd compartment of regional lymph nodes which have been considered to be "skip metastases". This characteristic distribution of SNs is attributed to the multi-directional lymphatic drainage routes from the esophagus. Clinical application of sentinel node navigation surgery will be expected to play a key role for individualized mutimodal therapy in patients with cT1N0 esophageal cancer.